Howard Richard F, Lloyd-Thomas Adrian, Thomas Mark, Williams D Glyn, Saul Rebecca, Bruce Elizabeth, Peters Judy
Department of Anaesthesia and Pain Management, Great Ormond Street Hospital for Children, London, UK.
Paediatr Anaesth. 2010 Feb;20(2):126-34. doi: 10.1111/j.1460-9592.2009.03242.x.
Patients who received NCA with morphine following major surgery between 1996 and 2008 at Great Ormond Street Hospital, London, UK, were prospectively studied in the postoperative period to determine effectiveness, morphine requirements, incidence of common side effects, and serious adverse events.
The morphine NCA regimen and monitoring was according to standard hospital protocols. Data were collected prospectively and subsequently entered by trained personnel into a secure database. Patient demographics, effectiveness and satisfaction rates, morphine requirements, side effects, and serious complications were recorded.
10,079 patients were included. The average age was 4 years old (range 1 day to 20.5 years, median 2.3 years). There were 510 neonates. The average NCA duration was 43.7 h. 1.8% of morphine NCAs were replaced by other methods because analgesia was unsatisfactory. Satisfaction ratings were 'good' or 'very good' for 98% of the remainder. Average daily morphine requirement (mcg x kg(-1) x h(-1)) was related to age, surgical category, and postoperative time. Side effects included PONV (25%), itching (9.4%), depression of respiration, and sedation (4.5%); incidences varied with age, morphine dose, and type of surgery. Serious, potentially life-threatening adverse effects (SAE) were 0.4%. There were no deaths. SAE were significantly greater in neonates (2.5%), relative risk 9.4, P < 0.001. Morphine dose in neonates who experienced SAE was not significantly different from other neonates.
NCA with morphine is an acceptable, safe, and effective method of postoperative analgesia for a wide range of ages and types of surgery in our practice. Morphine requirements increase with age, but there was also considerable inter-individual variation within age groups. PONV, itching, sedation, and respiratory depression are expected side effects. SAE are uncommon but the incidence is greatest in neonates.
对1996年至2008年期间在英国伦敦大奥蒙德街医院接受大手术后使用吗啡进行非连续性自控镇痛（NCA）的患者进行术后前瞻性研究，以确定其有效性、吗啡需求量、常见副作用的发生率以及严重不良事件。
吗啡NCA方案及监测遵循医院标准规程。前瞻性收集数据，随后由经过培训的人员录入安全数据库。记录患者人口统计学信息、有效性及满意度、吗啡需求量、副作用和严重并发症。
共纳入10079例患者。平均年龄为4岁（范围1天至20.5岁，中位数2.3岁）。其中有510例新生儿。平均NCA持续时间为43.7小时。1.8%的吗啡NCA因镇痛效果不佳而被其他方法替代。其余患者中98%的满意度评级为“良好”或“非常好”。平均每日吗啡需求量（微克×千克⁻¹×小时⁻¹）与年龄、手术类别及术后时间相关。副作用包括恶心呕吐（25%）、瘙痒（9.4%）、呼吸抑制和镇静（4.5%）；发生率随年龄、吗啡剂量及手术类型而异。严重的、可能危及生命的不良反应（SAE）发生率为0.4%。无死亡病例。新生儿的SAE发生率显著更高（2.5%），相对风险为9.4，P<0.001。发生SAE的新生儿的吗啡剂量与其他新生儿无显著差异。
在我们的实践中，吗啡NCA是一种适用于广泛年龄和手术类型的可接受、安全且有效的术后镇痛方法。吗啡需求量随年龄增加，但各年龄组内个体差异也较大。恶心呕吐、瘙痒、镇静和呼吸抑制是预期的副作用。SAE不常见，但在新生儿中发生率最高。
