【摘要】 目的:探讨儿童围术期镇痛的必要性及椎管阻滞应用的可行性。方法:以"pediatric patient,analgesia,perioperat"为检索词,检索1990-01/2004-12PubMed数据库关于儿童围术期镇痛的文献,选取随机对照研究设计的文献,对其中14篇进行归纳总结。结果:①疼痛的并发症:儿童围术期的疼痛不但与成人一样影响血流动力学稳定、增加术后并发症和死亡率;还可导致慢性疼痛综合征、注意力不集中、学习能力下降等并发症。②多模式镇痛:疼痛治疗可在形成疼痛的转化、传导、整合、认知4个水平采取措施。复合使用多种作用机制不同的药物可以减少每种药物的用量,减少副作用,取得更好的疗效。采用超前镇痛,在伤害性刺激之前施行疼痛治疗,只有当伤害性刺激完全被阻断时,超前镇痛的优势才能显现出来,而且阻断时效应该比术后急性疼痛时间长。③疼痛的评价:目前临床常用评分方法是NIPS(neonatalinjurypainscale)评分系统,包括面部表情、哭吵、呼吸形式、上下肢运动和觉醒状态5个指标。评分越低说明疼痛越轻。④围术期椎管阻滞镇痛治疗:重点介绍硬膜外技术、硬膜外常用药物及剂量、适应证、并发症等。结论:有必要对儿童施行围术期镇痛,椎管阻滞是儿童围术期镇痛一种切实可行的方法。更多还原

【Abstract】 AIM: To explore the essentiality of analgesia in perioperation and the feasibility of intraspinal block in children. METHODS:Relevant articles of analgesia in perioperation were retrieved from the PubMed database with the of "pediatric patient, analgesia,perioperat" published from January 1990 to December 2004. Articles of randomized controlled researches were collected, and 14 were selected for summarization. RESULTS: ①complication of pain: Pain in perioperation not only affected the stability of hemodynamics, increase of postoperative complications and death rate as adults, but also could induce chronic pain syndrome, impaired concentration, decreased learning capacity and so on. ②multiple modes of analgesia: Treatment of pain could conduct in transformation, transmission, integration and cognition. Combination of different drugs with many mechanisms could decrease the dosage of each drug and side effects, and obtain better curative effect. By preemptive analgesia, pain treatment was performed before nociceptive stimulus. Only when nociceptive stimulus was fully blocked, the advantage of preemptive analgesia would appear, and the time-effect of block should be longer than postoperative acute pain. ③pain evaluation: At present, commonly used assay was neonatal injury pain scale (NIPS), which included 5 indexes, namely facial expression, crying and noising, type of breathing, movement of upper and lower limbs and waking state. The lower the score, the milder the pain was. ④analgesia treatment of perioperative intraspinal block: It focused to introduce epidural techniques, epidural commonly used drug and dosage, indication, complication and so on. CONCLUSION:It is necessary to perform perioperative analgesia in children. Intraspinal block is a feasible technique in perioperative analgesia of children.更多还原