Jiang Hong-hua, Cheng Rui, Kan Qing, Shen Xian, Li Fang, Fu Cai-hong, Zhou Xiao-yu
Department of Neonatology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing 210008, China.
Zhonghua Er Ke Za Zhi. 2012 May;50(5):350-5.
To evaluate the effects of morphine infusion analgesia on behavioural and neuroendocrine stress response and short term outcome in ventilated neonates.
A randomized, double-blind clinical trial was conducted between August 2010 and April 2011 at the neonatal intensive care unit of Nanjing Children's Hospital Affiliated to Nanjing Medical University. A total of 46 ventilated preterm infants (≥ 32 weeks) and term infants were divided into 2 groups at random. Twenty-two infants in test group received a loading dose (100 µg/kg) of morphine (> 1 h) followed by a continuous infusion [10 µg/(kg·h)] for (70.05 ± 29.05) h, and 24 infants in control group received 5% glucose with the same infusion rate. (1) The ventilatory parameters [respiratory rate (R), frequence (f), peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), fraction of inspired oxygen (FiO2)], mean blood pressure (MBP) and heart rate (HR) before treatment, at 30 min, 2 h, 6 h, 12 h, 24 h, 48 h after treatment between two groups were compared. (2) Pain was measured by two assessment tools [neonatal pain, agitation and sedation scale (N-PASS) and COMFORT scale] at the same periods. (3) The ventilation duration, the time from withdrawal to extubation, the total oxygen-inhaled time, the side effects and the clinical outcomes [e.g., pulmonary hemorrhage, air leak, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH)] between two groups were compared.
(1) There were no significant differences in the different ventilatory parameters before and after treatment between two groups at different periods (P > 0.05). There was no significant difference in the average blood pressure of two groups at different periods, but the heart rate reduced at 24 - 48 h after treatment in test group with significant difference as compared to control group (t = -2.152 and -2.513, P < 0.05). (2) The N-PASS score and COMFORT score in test group were lower than that in control group at different time points 2 h after treatment (P < 0.05), especially 12 h after treatment (P < 0.01). (3) There were no significant differences in the ventilation duration, the time from withdrawal to extubation and the total oxygen time between two groups, and also in side effects, the incidence of IVH, white matter damage and the clinical outcomes.
Continuous infusion of morphine could relieve pain in ventilated neonates, reduce the stress response and promote the human-machine coordination, but the medication did not show any effects on neurobehavioral development and short term outcome.
评估吗啡静脉输注镇痛对机械通气新生儿行为及神经内分泌应激反应和短期预后的影响。
2010年8月至2011年4月在南京医科大学附属南京儿童医院新生儿重症监护病房进行一项随机双盲临床试验。共46例机械通气的早产儿（≥32周）和足月儿被随机分为2组。试验组22例婴儿先给予负荷剂量（100μg/kg）吗啡（>1小时），随后持续输注[10μg/（kg·h）]（70.05±29.05）小时，对照组24例婴儿给予相同输注速率的5%葡萄糖。（1）比较两组治疗前、治疗后30分钟、2小时、6小时、12小时、24小时、48小时的通气参数[呼吸频率（R）、潮气量（f）、吸气峰压（PIP）、呼气末正压（PEEP）、吸入氧分数（FiO2）]、平均血压（MBP）和心率（HR）。（2）在同一时期用两种评估工具[新生儿疼痛、躁动和镇静量表（N-PASS）和COMFORT量表]测量疼痛。（3）比较两组的通气时间、撤机至拔管时间、总吸氧时间、副作用及临床结局[如肺出血、气漏、动脉导管未闭（PDA）、坏死性小肠结肠炎（NEC）、脑室内出血（IVH）]。
（1）两组在不同时期治疗前后不同通气参数比较差异无统计学意义（P>0.05）。两组不同时期平均血压比较差异无统计学意义，但试验组治疗后24～48小时心率降低，与对照组比较差异有统计学意义（t=-2.152和-2.513，P<0.05）。（2）试验组治疗后2小时不同时间点N-PASS评分和COMFORT评分低于对照组（P<0.05），尤其治疗后12小时（P<0.01）。（3）两组通气时间、撤机至拔管时间和总吸氧时间比较差异无统计学意义，副作用、IVH发生率、脑白质损伤及临床结局比较差异亦无统计学意义。
持续输注吗啡可缓解机械通气新生儿疼痛，减轻应激反应，促进人机协调，但对神经行为发育及短期预后无明显影响。
