新生儿术后镇痛的临床进展

张弦; 晏馥霞; 陈凌宇; 潘守东

doi:10.16766/j.cnki.issn.1674-4152.002867

新生儿术后镇痛的临床进展

doi: 10.16766/j.cnki.issn.1674-4152.002867

1.
北京协和医学院首都儿科研究所，北京 100020
2.
北京协和医学院中国医学科学院阜外医院麻醉科，北京 100037
3.
首都儿科研究所附属儿童医院麻醉科，北京 100020

基金项目:

首都临床特色应用研究基金资助项目 Z181100001718096

首都儿科研究所所级课题培育项目 PY-2020-08

详细信息

通讯作者:
潘守东, E-mail: adohn@163.com

中图分类号: R726.1 R971.2
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-23
- 网络出版日期: 2023-04-20

Clinical progress of postoperative analgesia in neonates

1.
Capital Pediatric Institute/Peking Union Medical College, Beijing 100020, China

摘要

摘要: 由于新生儿自身的发育生理和药代动力学特点，临床上针对这一人群的术后镇痛仍然受到一定程度的限制。新生儿尤其是早产儿仅被提供最少甚至不进行麻醉和镇痛。随着对生理学的深入研究，新生儿镇痛的重要性越来越受到临床医师的重视，术后镇痛也开始向按需的多模式镇痛方向发展。临床上针对新生儿出现各种各样的术后镇痛方式，但目前仍未有针对新生儿术后镇痛的药物和措施制定统一的指南，临床医师对新生儿术后镇痛的实施仍有顾虑。因此本文对已有的新生儿术后镇痛的方法进行总结，数据主要来自已发表的临床研究、病例报道和个案报道，对术后镇痛中使用的各类药物的具体用量、镇痛效果、不良反应和注意事项等进行统计，以便于临床医生应用时可以根据患儿的具体情况选择合适的镇痛方法。根据镇痛药物分类，包括阿片类药物如吗啡、芬太尼、舒芬太尼、曲马多，非阿片类药物如对乙酰氨基酚，酮咯酸，吡硝胺，局部麻醉药如布比卡因、罗哌卡因、氯普鲁卡因、利多卡因、混合局麻药，并对相同药物的不同给药方式和途径进行了总结和分析。非药物镇痛方法包括给予高糖溶液、非营养性吸吮、体位改变等措施。新生儿的特殊性使各类操作和效果评估的难度和风险均提高，各类镇痛方法仍需大量临床研究进行验证。
- 新生儿 /
- 术后镇痛 /
- 不良反应
Abstract: Given the developmental physiological and pharmacokinetic characteristics of neonates, the postoperative analgesia for this population remains limited to a certain extent. Neonates, particularly preterm infants, are only provided with minimal or no anaesthesia and analgesia. With the in-depth study of physiology, the importance of neonatal analgesia has been paid considerable attention, and postoperative analgesia has begun to develop towards on-demand multi-mode analgesia. Postoperative analgesia for neonates in clinic has various ways, but no unified guide is developed for the drugs and measures of neonatal postoperative analgesia, and clinicians still have concerns about the implementation of neonatal postoperative analgesia. Therefore, this paper summarised the existing methods of postoperative analgesia for neonates. The data are primarily obtained from published clinical studies and case reports, and the specific dosage, analgesic effect, adverse reactions and precautions of various drugs used in postoperative analgesia were counted; thus, clinicians can select appropriate analgesic methods based on the specific situation of children. Based on the classification of analgesic drugs, including opioids (morphine, fentanyl, sufentanil and tramadol), non-opioid drugs (acetaminophen, ketorolac and pyrinidamine), local anaesthetics (bupivacaine, ropivacaine, chloroprocaine and lidocaine) and mixed local anaesthetics EMLA, the different ways and means of administration of the same drug were also summarised and analysed. Non-drug analgesic methods also include high-sugar solution, non-nutritive sucking, posture change and so on. The particularity of neonates increases the difficulty and risk of various operations and effect evaluation. Various analgesic methods still need to be verified by a large number of clinical studies.
- Neonate /
- Postoperative analgesia /
- Adverse reaction

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参考文献(50)

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