【摘要】 目的　探讨小儿硬膜外腔超前、术毕和术后注射吗啡的临床镇痛效果及安全性。方法　８０ 例硬膜外麻醉下行下肢手术的小儿随机分为ＥＭ、ＮＳ、ＰＭ 及ＰＯ组；ＥＭ组在硬膜外注药前２０ ｍｉｎ 经导管注０ ．０４ ｍｇ·ｋｇ－１ 吗啡５ ｍｌ，ＰＭ组在术毕经导管注同量吗啡，ＮＳ组注同容量生理盐水，ＰＯ组在术后２ ｈ 经导管注同量吗啡。术后３６ ｈ内随访并记录疼痛（ＶＡＳ） 、镇静及恶心呕吐（ＰＯＮＶ） 评分、平均动脉压和尿潴留等并发症的发生率。结果　ＥＭ、ＰＭ及ＰＯ组术后２４ ｈ ＶＡＳ和ＰＯＮＶ评分均低于ＮＳ组，镇静评分高于ＮＳ组（ Ｐ＜ ０．０５） ；ＥＭ 组术后２ ｈ ＶＡＳ和ＰＯＮＶ评分高于ＰＭ组，４ ｈ ＰＯＮＶ评分低于ＰＭ 组（ Ｐ＜０．０５） 。结论　经充分补液后，小儿硬膜外吗啡超前和术毕使用均可安全地用于术后镇痛。更多还原

【Abstract】 Objective To evaluate the efficacy and side effects of epidural preemptive ,end-operative and after-operative morphine injected for postoperative analgesia in children.?Methods Eighty children (ASA ⅠorⅡ) undergoing lower extremity surgery with epidural anesthesia were randomly assigned to 4 groups. Group EM were given 0.04 mg·kg -1 of morphine in 5 ml bolus injected into epidural space before lidocaine injection; group PM, equal morphine injected at the end of operation; group NS, same volume of normal saline injected; and group PO, equal morphine injected 2 h after operation. The children were followed up at 2,4,6,12,24,36 h after operation, and the degrees of pain, sedation and postoperative nausea and vomiting (PONV) were assessed.?Results The volume of lidocaine in group EM was less than that in the other 3 groups (P<0.05). In the interval between 0 h and 24 h following surgery, the pain scores and PONV scores were higher and the degree of sedation were less in group NS than in the other 3 groups .The efficacy and the side effects in group PM were similar to those in group EM and group PO.?Conclusion Preemptive and end-operative epidural morphine injection both are safe postoperative pain relief methods in children.更多还原