Schiessl C, Schestag I, Griessinger N, Sittl R, Zernikow B
Anästhesiologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
Schmerz. 2009 Feb;23(1):7-19. doi: 10.1007/s00482-008-0734-9.
In order to match the interindividual and intraindividual differences in opioid requirements of pediatric oncology patients with mucositis, patient-controlled analgesia (PCA) seems to be the optimal pain therapy option, but scientific data are lacking.
A retrospective chart review of PCA-treated children with mucositis was carried out over a 6-year period (2000-2006) at the university hospital for children in Erlangen.
The median age of the patients was 12.6 years and they mainly suffered from forms of acute leukemia. Daily morphine equivalent dose (MED) requirements increased with the start of the PCA therapy from 14.5 mg/day to 18.7 mg/day (p=0.021; Wilcoxon test). Children required more opioids by bolus request during the night (10:01 p.m. to 06:00 a.m.; 6.28 mg; 13%) than during the other 8-hour intervals (06:01 a.m. to 02:00 p.m. and 02:01 p.m. to 10:00 p.m.; both 21.3 mg (43.5%) during the whole 10-day study period. In 8 out of 10 days there was a significant diurnal variation in opioid requirement with significantly lower requirement during the night (p<0.05 Friedman test). The median count of delivered and un-delivered bolus requests during the night was 0-1 and 0, respectively.
PCA seems to be an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose in children with chemotherapy-induced mucositis. This is expressed through the increase in daily self-administered opioid doses after starting PCA, the huge interindividual variability in opioid consumption and the rare event of an un-delivered bolus request during lock-out time. With the use of a background infusion, additional bolus requests are rare during the night.
为了应对儿科肿瘤黏膜炎患者对阿片类药物需求的个体间和个体内差异，患者自控镇痛（PCA）似乎是最佳的疼痛治疗选择，但缺乏科学数据。
在埃尔朗根大学儿童医院对PCA治疗的黏膜炎患儿进行了为期6年（2000 - 2006年）的回顾性病历审查。
患者的中位年龄为12.6岁，主要患有急性白血病。PCA治疗开始后，每日吗啡当量剂量（MED）需求从14.5毫克/天增加到18.7毫克/天（p = 0.021；Wilcoxon检验）。患儿在夜间（晚上10:01至早上6:00；6.28毫克；13%）通过追加剂量请求所需的阿片类药物比其他8小时间隔（早上6:01至下午2:00和下午2:01至晚上10:00；在整个10天研究期间均为21.3毫克（43.5%））更多。在10天中的8天，阿片类药物需求存在显著的昼夜变化，夜间需求显著降低（p < 0.05；Friedman检验）。夜间已交付和未交付的追加剂量请求的中位数分别为0 - 1和0。
对于化疗引起黏膜炎的儿童，PCA似乎是一种理想、可靠且可行的镇痛给药方式，可用于个体剂量滴定。这表现为开始PCA后每日自我给药的阿片类药物剂量增加、阿片类药物消耗的巨大个体间变异性以及锁定时间内未交付追加剂量请求的罕见情况。使用背景输注时，夜间追加剂量请求很少。
