Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, Level 4, Old Building, Great Ormond Street, London WC1N 3JH, UK.
Magill Department of Anaesthesia, Critical Care and Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
Br J Anaesth. 2017 Feb;118(2):239-246. doi: 10.1093/bja/aew403.
Children with neurodevelopmental disabilities may be at risk of opioid-induced respiratory depression. We aimed to quantify the risks and effectiveness of morphine nurse-controlled analgesia (morphine-NCA) for postoperative pain in children with neurodevelopmental disabilities.
We carried out a retrospective cohort study of 12 904 children who received postoperative i.v. morphine-NCA. Subjects were divided into a neurodevelopmental disability group and a control group. Rates of clinical satisfaction, respiratory depression, and serious adverse events were obtained, and statistical analysis, including multilevel logistic regression using Bayesian inference, was performed.
Of 12 904 patients, 2390 (19%) had neurodevelopmental disabilities. There were 88 instances of respiratory depression and 52 serious adverse events; there were no opioid-related deaths. The cumulative incidence of respiratory depression in the neurodevelopmental disability group was 1.09% vs 0.59% in the control group [odds ratio 1.8 (98% chance that the true odds ratio was >1)]. A significant interaction between postoperative morphine dose and neurodevelopmental disabilities was observed, with higher risk of respiratory depression with increasing dose. Satisfaction with morphine-NCA was very high overall, although children with neurodevelopmental disabilities were 1% more likely to have infusions rated as fair or poor (3.3 vs 2.1%, χP<0.001).
Children with neurodevelopmental disabilities were 1.8 times more likely to suffer respiratory depression, absolute risk difference 0.5%; opioid-induced respiratory depression in this group may relate to increased sensitivity to dose-relate respiratory effects of morphine. Morphine-NCA as described was an acceptable technique for children with and without neurodevelopmental disabilities.
神经发育障碍儿童可能存在阿片类药物引起的呼吸抑制风险。我们旨在量化吗啡自控镇痛（morphine-NCA）在神经发育障碍儿童术后疼痛中的风险和疗效。
我们对 12904 例接受术后静脉内吗啡-NCA 的儿童进行了回顾性队列研究。将受试者分为神经发育障碍组和对照组。获得临床满意度、呼吸抑制和严重不良事件的发生率，并进行统计分析，包括使用贝叶斯推断的多水平逻辑回归。
在 12904 例患者中，2390 例（19%）存在神经发育障碍。有 88 例呼吸抑制和 52 例严重不良事件；无阿片类药物相关死亡。神经发育障碍组呼吸抑制的累积发生率为 1.09%，对照组为 0.59%[比值比 1.8（真实比值比大于 1 的可能性为 98%）]。术后吗啡剂量与神经发育障碍之间存在显著的交互作用，随着剂量的增加，呼吸抑制的风险增加。总体而言，对吗啡-NCA 的满意度非常高，尽管神经发育障碍儿童的输注被评为一般或较差的可能性高 1%（3.3%比 2.1%，χP<0.001）。
神经发育障碍儿童发生呼吸抑制的风险增加 1.8 倍，绝对风险差异为 0.5%；该组中阿片类药物引起的呼吸抑制可能与对吗啡剂量相关呼吸作用的敏感性增加有关。描述的吗啡-NCA 是一种可接受的技术，适用于有和没有神经发育障碍的儿童。
