氯胺酮麻醉患儿术后疼痛程度的变化:Meta分析

目的 采用Meta分析法评价氯胺酮麻醉患儿术后疼痛程度的变化.方法 检索Cochrane图书馆、PubMed、OVID、EMBASE和中国生物医学文献数据库,收集氯胺酮麻醉患儿术后疼痛程度变化的前瞻性临床随机对照研究.采用Cochrane协作网系统评价纳入文献的质量,评价指标包括:术后6h内疼痛评分和镇痛药物用量、术后6～24h内疼痛评分和镇痛药物用量、感觉阻滞时间(骶管阻滞)和术后24h内不良反应(恶心呕吐和精神类症状)发生情况.采用RevMan 5.0软件进行Meta分析.结果 共纳入15项研究,包括955例患者,其中对照组455例,氯胺酮组500例.氯胺酮全身麻醉患儿术后6h内疼痛评分降低,镇痛药物用量减少;氯胺酮局部麻醉患儿术后6～24h疼痛评分降低,术后6h内镇痛药物用量减少;氯胺酮骶管阻滞患儿感觉阻滞持续时间延长,术后6h内镇痛药物用量减少.氯胺酮麻醉患儿术后恶心呕吐和精神类症状的发生率无变化.结论 氯胺酮麻醉患儿术后6h内疼痛程度减轻,镇痛药物用量减少.     

脊髓GABAA受体在异丙酚对内脏痛大鼠镇痛效应中的作用

目的 评价脊髓γ-氨基丁酸A(GABAA)受体在异丙酚对内脏痛大鼠镇痛效应中的作用.方法成年健康雌性SD大鼠,体重190～240 g,进行鞘内置管,并于直肠粘膜下注射10%福尔马林100 μl.取鞘内置管成功的大鼠32只,采用随机数字表法,将其随机分为4组(n=8):二甲基亚砜组(D组)、异丙酚组(P组)、荷包牡丹碱组(B组)和荷包牡丹碱+异丙酚组(BP组).D组、P组和B组分别鞘内注射二甲基亚砜5 μl、异丙酚10 μg、荷包牡丹碱2 μg;BP组先鞘内注射荷包牡丹碱2 μg,10min后鞘内注射异丙酚10 μg.注射福尔马林2 h时,取脊髓L5～S1节段,采用免疫组化法测定FOS蛋白表达水平.结果 与D组和B组比较,P组脊髓FOS蛋白表达下调(P＜0.05);D组和B组脊髓FOS蛋白表达差异无统计学意义(P＞0.05);与P组比较,BP组脊髓FOS蛋白表达上调(P＜0.05).结论 异丙酚可通过脊髓GABAA受体介导,对内脏痛大鼠产生镇痛效应.

Abstract：

Objective To evaluate the role of spinal cord CABAA receptors in the analgesic effect of propofol on visceral pain in rats. Methods Adult female SD rats, weighing 190-240 g, were used in this study.The animals were anesthetized with intraperitoneal ketamine 50-100 mg/kg. Intrathecal (IT) catheters were placed at L5-6 interspace according to the technique described by Storkson et al. Thirty-two animals in which IT catheters were successfully placed were randomly divided into 4 groups ( n = 8 each) : dimethyl sulphoxide (DMSO) group (group D), propofol group (group P), bicuculline group (group B) and bicuculline + propofol group (group B +P). Visceral pain was induced by injecting 10% formalin 100 μl underneath the mucous membrane of rectum.Groups D, P and B received IT DMSO 5 μl, propofol 10 μg and bicuculline 2 μg respectively. Group BP received IT bicuculline 2 μg and then IT propofol 10 μg 10 min later. The L5-S1 segment of the spinal cord was removed 2 h after formalin injection to determine FOS protein expression by hnmuno-histochemistry. Results Compared with groups D and B, FOS protein expression was significantly down-regulated in group P ( P ＜ 0.05 ) . There was no significant difference in FOS protein expression between groups D and B ( P ＞ 0.05) . FOS protein expression was significantly up-regulated in group BP compared with group P ( P ＜ 0.05) . Conclusion Propofol has analgesic effect on visceral pain in rats through spinal cord GABAA receptor action.     

异丙酚对腹腔镜胆囊切除病人术后恶心呕吐的防治作用

目的 探讨异丙酚的镇吐作用及可能的作用机制。方法 60例ASAⅠ－Ⅱ级行择期腹腔镜胆囊切除术患者,随机分为三组;对照组（C组）行常规气管插管吸入全麻,恩丹西酮组（O组）入室后静脉注射恩丹西酮4mg,其他处理C组,异丙酚组（P组）诱导插管同C组,麻醉维持用异丙酚微泵静滴。分别测定入室（基础值）、气管插管后、术毕、术后6h血浆胃动素的水平,并观察术后恶心呕吐程度及发生率。结果 C组20例中9例发生Ⅱ－Ⅲ级恶心、呕吐,发生率为56．7％,O组为4例,P组为3例,发生率分别为20％、13．3％。围术期胃动素水平：C组术毕明显高于基础值（P＞0．01）,术后P明显低于C组及O组。结论 异丙酚静脉麻醉能降低腹腔镜胆囊切除术后恶心呕吐发生率,可能与抑制血浆胃动素合成及分泌有关。     

异丙酚冷藏后静脉注射预防静脉疼痛的观察

目的：探索异丙酚无痛性静脉注射的方法。方法：将异丙酚冷藏至10℃后，取其19ml 2％利多卡因1ml混合后作静脉注射，共40例，与其他三种不同的异丙酚用药方法(共60例)进行比较。结果：冷藏异丙酚 利多卡因组无一例出现疼痛主诉，对血压、心率的影响与其它三组方法比较，无显著差异。结论：冷藏异丙酚加利多卡因静脉注射法，可安全做到静脉无痛。     

不同麻醉方式下胃癌根治术后患者疼痛程度的比较

目的 比较不同麻醉方式下胃癌根治术后患者的疼痛程度.方法 择期拟行胃癌根治术患者102例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄50～75岁,体重45～70 ks,采用随机数字表法,将患者随机分为3组(n=34):单纯全麻组(GA组)、全麻联合肋缘下腹横肌平面阻滞组(CGTA组)和全麻联合硬膜外阻滞组(CGEA组).术后拔除气管导管后送至麻醉后恢复室(CPACU),患者入室时记录VAS评分.PACU期间评价疼痛程度,VAS评分＞3分的患者接受静脉吗啡滴定,VAS评分≤3分时停止吗啡滴定,接静脉自控镇痛泵和/或硬膜外镇痛泵.滴定结束时记录吗啡总用量,观察不良反应的发生情况.结果 与GA组和CGTA组比较,CGEA组术后中重度痛发生率降低(P＜0.01);GA组、CGTA组和CGEA组患者术后重度痛发生率、入室时VAS评分及吗啡总用量依次降低(P＜0.01);CGEA组镇静发生率低于GA组(P＜0.01),三组其余不良反应发生率比较差异无统计学意义(P＞0.05).结论 全麻、全麻联合肋缘下腹横肌平面阻滞和全麻联合硬膜外阻滞下胃癌根治术后患者的疼痛程度依次降低.     

异丙酚对内脏痛大鼠脊髓背角使君子酸受体GluR1亚基磷酸化水平的影响

目的 探讨异丙酚对内脏痛大鼠脊髓背角使君子酸(AMPA)受体谷氨酸受体1(GluRl)亚基831和845位点丝氨酸磷酸化水平的影响.方法 成年雄性SD大鼠,体重200～300 g,6～8周龄,行鞘内置管术,5d后选取鞘内置管成功的大鼠30只,采用随机数字表法,将其随机分为3组(n=1 0):假手术组(Ⅰ组)、内脏痛组(Ⅱ组)和异丙酚组(Ⅲ组).Ⅱ组和Ⅲ组采用经直肠注射50μl10％辣椒素的方法制备内脏痛模型,Ⅰ组给予等容量生理盐水,Ⅲ组于给予辣椒素前10 min鞘内注射异丙酚20μg,Ⅰ组和Ⅱ组给予等容量二甲基亚砜.记录给予辣椒素后30 min内大鼠累计痛评分,然后处死大鼠,取L3-6腰骶段脊髓背角组织,采用免疫印迹法检测AMPA受体GluR1亚基及其831和845位点丝氨酸磷酸化水平.结果与Ⅰ组比较,Ⅱ组和Ⅲ组累计痛评分和脊髓背角GluR1亚基831和845位点丝氨酸磷酸化水平升高(P ＜0.05或0.01),而GluR1亚基表差异无统计学意义(P＞0.05);与Ⅱ组比较,Ⅲ组累计痛评分和脊髓背角GluR1亚基831和845位点丝氨酸磷酸化水平降低(P＜0.05或0.01).结论 异丙酚可减轻大鼠内脏痛,其机制与抑制脊髓背角AMPA受体GluR1亚基831和845位点丝氨酸磷酸化有关.     

神经外科术后疼痛的调查

本文旨在调查神经外科术后疼痛发生率、疼痛程度以及术后恶心呕吐和镇静水平，为术后疼痛治疗提供依据。资料与方法9４例择期脑外科手术病人，男５１例，女４３例，年龄１７～６５岁。临床诊断如下：（１）肿瘤患者 ７２例（７６．６％），包括脑膜瘤１２例、胶质瘤１７例、听神经瘤９例、垂体瘤２１例、颅咽管瘤７例、其它肿瘤 ６例；（２）血管病患者 ２２例（２３．４％），包括颅内动脉瘤１６例、动静脉畸形３例、海绵状血管瘤３例．本研究病例入选条件ＡＳＡⅠ～Ⅱ级，术前无癫痛病史及呼吸功能障碍，术后１ｈ内病人定向力恢复。病例排…     

损伤反应和术后疼痛的预防

国际疼痛研究会(IASP)急性疼痛组以预防性措施为重点正在广泛研究处理急性疼痛的方法。随着公众对疼痛治疗的了解和期望,医务人员对疼痛处理的训练、知识和实践也必须相应改变,以求减少不必要的术后疼痛和损伤反应。防止术后疼痛的理论基础已有大量资料证实,组织损伤能使外周痛觉感受器敏感化,甚至产生超敏(hypersensitivity)。近年又证实某些炎性反应的组织、血液和神经成分能在外周水平引起原发性或继发性“过痛”(hypcralgcsia),所以就有可能寻求到作用于外周痛觉传入神经元的新措施和镇痛药,     

持续性术后痛大鼠脊髓星形胶质细胞的活化

目的 探讨持续性术后痛大鼠脊髓背角星形胶质细胞的活化.方法 成年雄性SD大鼠48只,体重200～250 g,随机分为2组(n=24):假手术组和模型组.模型组采用皮肤肌肉切口牵拉术制备持续性术后痛模型,假手术组仅暴露内收肌,不牵拉皮肤肌肉组织.分别于模型制备前(基础状态)、制备后1、3、12、22和32 d时测定大鼠机械缩足阈值(MWT).各时点MWT测定结束后随机取4只大鼠,处死后采用免疫组织荧光法测定脊髓胶质纤维酸性蛋白(GFAP)的表达水平.结果 与基础值比较,假手术组各时点MWT和脊髓GFAP表达水平差异无统计学意义(P＞0.05),模型组模型制备后1～22 d MWT降低,12 d时最低,模型制备后3～22 d脊髓GFAP表达上调,12 d时达峰值(P＜0.05或0.01);与假手术组比较,模型组MWT降低,脊髓GFAP表达上调(P＜0.05).结论 大鼠持续性术后痛与脊髓星形胶质细胞的活化有关.     

急性术后疼痛危险因素和疼痛程度预测方法的研究进展

急性术后疼痛(APP)是患者受到手术刺激后出现的一系列生理、心理及行为反应等,主要集中在术后24～72 h,常持续4～6 d.APP严重影响手术预后,而导致患者APP治疗不充分的原因较多,因此,APP的管理重点在于对疼痛的评估和预防,充分理解和掌握APP危险因素和疼痛程度预测方法对于APP的管理十分必要.APP的危险因...     

Audit of postoperative pain control Influence of a dedicated acute pain nurse

The inadequacies of conventional intramuscular opioid analgesia have fuelled an expansion in the use of patient-controlled analgesia and epidural analgesia after surgery. This is not always accompanied by increased education and specialist supervision of ward staff and patients. A survey in our hospital prior to the appointment of an Acute Pain Nurse showed an unacceptable incidence of side effects when epidural analgesia was employed on ordinary surgical wards. More surprisingly, efficacy of patient-controlled analgesia was found to be low. Frequent review of patients and regular education of ward staff by a specialist Pain Nurse have achieved a substantial reduction in side effects of epidural analgesia and improvement in efficacy of patient-controlled analgesia. We have shown that the advantages of patient-controlled analgesia can be largely negated by failure to address deficiencies in knowledge of pain management amongst ward staff and patients.     

急性疼痛服务团队早期干预对患者术后自控镇痛效果的影响

目的 评价急性疼痛服务( APS)团队早期干预对术后白控镇痛效果的影响.方法 选择2011年11～12月,在本院手术并要求术后镇痛的患者1467例,按手术月份分为对照组和干预组,其中11月份患者为对照组(n =725),12月份患者为干预组(n=742).术后均采用舒芬太尼PCIA.对照组由负责麻醉的医生和责任护士常规术前宣教、介绍PCA使用的意义、操作要点、注意事项,嘱咐患者疼痛时,按压电子镇痛泵,如10min后无缓解,由APS医生调整镇痛泵参数或加用其他镇痛药物;干预组由麻醉科APS医生、复苏室专职疼痛护士和病房疼痛护士给予系统的疼痛控制教育,包括PCA使用的意义、操作要点、镇痛药物的介绍和注意事项、疼痛评估方法及超前镇痛的必要性,在手术前和出复苏室前给予2次疼痛教育,嘱咐患者在活动前或轻度疼痛时(VAS≤3分)按压自控镇痛泵,疼痛剧烈时由APS医生调整镇痛泵参数或加用其他镇痛药物.记录镇痛不全、不良反应的发生情况及患者满意度.结果 与对照组比较,干预组镇痛不全发生率降低,患者满意度升高(P＜0.05),不良反应发生率差异无统计学意义(P＞0.05).结论 APS团队早期干预可增强术后自控镇痛效果,提高患者的满意度.     

The effect of education, assessment and a standardised prescription on postoperative pain management The value of clinical audit in the establishment of acute pain services

A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy.     

腹部手术后患者静脉输注丁丙诺啡镇痛的可行性

目的 评价腹部手术后患者静脉输注丁丙诺啡镇痛的可行性.方法 采用多中心、随机、开放、平行、阳性药物对照进行研究,择期全身麻醉下行腹部手术患者200例,年龄18～64岁,ASAⅠ级或Ⅱ级,性别不限,体重50～100 kg,随机分为丁丙诺啡组(B组)和芬太尼组(F组),每组100例.2组术后分别静脉输注丁丙诺啡0.3 μg·kg-1·h-1、芬太尼0.3 μg·kg-1·h-1.采用视觉模拟评分法(VAS评分)评价术后6、12、24、36和48 h的疼痛程度,于各时点行镇静评分及Prince-Henry评分,监测心率、呼吸频率(RR)和脉搏血氧饱和度(SpO2),记录不良反应的发生情况.结果 与F组比较,B组各时点VAS评分、镇静评分和Prince-Henry评分差异无统计学意义(P＞0.05),恶心发生率较低(P＜0.05);两组各时点RR和SpO2差异无统计学意义(P＞0.05).结论 静脉输注丁丙喏啡0.3 μg·kg-1·h-1可有效缓解腹部手术后患者疼痛,且不良反应少.     

全膝关节置换术后膝关节疼痛的临床处理

目的 探讨全膝关节置换术(TKA)后膝关节疼痛的原因和临床处理方法.方法 2004年1月至2009年6月,收治TKA术后疼痛患者41例,其中男性9例9膝,女性32例35膝;年龄51～84岁,平均63.5岁.关节外疼痛6例中1例为1型复杂区域疼痛综合征(CRPS-1)行保守治疗,其余5例手术治疗.关节内疼痛35例中关节失稳4例、髌骨低位1例、假体悬挂致周围软组织磨损2例、胭肌腱撞击1例采用保守治疗,其余27例手术治疗.定期随访并记录膝关节美国膝关节学会评分(KSS评分)、疼痛视觉模拟评分(VAS评分).结果 41例均获随访,随访时间1～6年.关节外疼痛手术5例,末次随访VAS评分、KSS临床和功能评分分别为2.5±0.2、92.8±2.6和89.0±3.4,膝关节疼痛缓解,功能改善.1例CRPS-1保守治疗,效果尚可.关节内疼痛感染组12例中截肢1例、抗生素骨水泥隔体植入3例、二期翻修8例,随访感染均治愈,术后VAS、KSS临床和功能评分分别为3.8±0.2、88.3±4.6和85.0±4.6,和术前相比差异有统计学意义(P＜0.05).非感染组保守治疗8例,末次随访VAS、KSS临床和功能评分4.5±0.4、85.4±4.2和84.2±2.3;手术治疗15例,末次随访VAS、KSS临床和功能评分3.4±0.1、86.6±5.4和87.1±2.4,与术前相比差异有统计学意义(P＜0.05).结论 TKA术后疼痛需要对手术和患者情况进行系统评估以明确其原因,确诊后制定合理治疗方案一般可获得满意效果,确诊之前严禁手术干预.

Abstract：

Objective To evaluate causes and clinical management of postoperative pain after total knee arthroplasty(TKA). Methods From January 2004 to June 2009, 41 patients(44 knees)with knee pain post TKA were treated. There were 9 male and 32 female patients aging from 51 to 84 years with a mean of 63.5 years. The diagnosis followed to Brown diagnostic system. One case of extraarticular pain was complex regional pain syndrome type 1(CRPS-1)and underwent conservative treatment, the remaining 5cases were treated by surgery. Three cases of joint instability, 1 case of patellar baja, 2 cases of soft tissue impingement caused by overhang of the prosthesis, 1 case of popliteal tendon impact underwent conservative treatment, the other 27 cases underwent surgical intervention. The patients were followed up and the Knee Society Score(KSS)knee score, pain visual analog scale(VAS)score were recorded. Results Forty-one cases were followed up for 1 to 6 years. At the last time of follow-up, the 5 cases received surgical treatment to extra-articular pain showed VAS score as 2. 5 ± 0. 2, KSS clinical and functional score as 92. 8 ± 2. 6 and 89.0 ± 3.4. There was significantly difference compared with preoperative(P ＜ 0. 05). One case of CRPS-1 performed conservative treatment, the therapy was effective. In the infected 12 cases of intra-articular pain, 1 case received amputation, 3 cases received antibiotic bone cement insert, 8 cases received two stage revision. All infections were cured, and VAS score was 3. 8 ± 0. 2, KSS clinical score was 88. 3 ± 4.6,function score was 85.0 ± 4. 6 postoperatively, with significantly difference compared with preoperative(P ＜0. 05). In the 8 cases received conservative treatment in non-infected group, at the last time of follow-up,VAS score was 4. 5 ± 0. 4, KSS clinical and functional score was 85.4 ± 4. 2 and 84. 2 ± 2. 3, with significantly difference compared with preoperative(P ＜ 0. 05). Fifteen cases underwent surgical treatment,at the last time of follow-up, VAS score was 3.4 ± 0. 1, KSS clinical and functional score was 86. 6 ± 5.4and 87. 1 ± 2. 4, with significantly difference compared with preoperative(P ＜ 0. 05). Conclusions Patients with knee pain post TKA need systematic assessment to identify the causes. Appropriate treatment due to the positive diagnosis generally lead to satisfactory results, surgical intervention with indefinite causes is strictly prohibited.     

PainVision法评估妇科腹腔镜手术后疼痛程度的可靠性:与VAS评分的比较

目的 评价PainVision法测定妇科腹腔镜手术后疼痛的可靠性.方法 选择在瑞芬太尼-异丙酚-顺式阿曲库铵复合麻醉下行妇科腹腔镜手术患者20例,ASA分级Ⅰ或Ⅱ级,年龄30 ～ 45岁,于术后12、24、48 h分别采用PainVision法[采用前臂电刺激的电流强度对疼痛程度进行量化,以患者发生感受转移时的电流强度(Ip)对最初感觉到电刺激的电流强度(Ic)的相对值表示疼痛程度(PD):(Ip-Ic)/Ic×100％]和视觉模拟评分法(VAS)同步评估急性疼痛程度.结果 PD与VAS评分呈显著正相关,相关系数为0.902(P＜ 0.01).结论 PainVision法可用于妇科腹腔镜手术后疼痛的评估.     

Public perceptions of postoperative pain and its relief

In order to evaluate the general public's knowledge of postoperative pain and its management, a simple questionnaire was devised and sent out to five general practices in Scotland and Yorkshire. Questionnaires were completed voluntarily by 529 people attending their general practitioner for reasons not related to surgery. Five hundred and fifteen completed questionnaires were analysed. Two hundred and thirty-nine (46.4%) responders had undergone previous major surgery whereas 267 (51.8%) had not. Attitudes to pain varied greatly and confirm the findings of other surveys that amongst the general public there is little or no understanding of the nature of postoperative pain or of the methods available to treat it. Despite the published literature, the public have a high degree of confidence in the ability of doctors and nurses to treat such pain. Widespread public and professional education is required before further improvements can be made to such a universal and basic clinical problem.     

The acute pain service: effective or expensive care?

The effect of introducing an Acute Pain Service into a District General Hospital was evaluated by conducting an audit of pain, emesis, sleep and satisfaction before and after inception. A total of 1518 questionnaires were collected, in which surgical patients had been asked to assess their experience pre- and postoperatively. The introduction of an Acute Pain Service significantly (p < 0.0001) improved in-patient perception of pain relief upon return of consciousness after anaesthesia and for 2 days postoperatively, when compared with the experience before its inception. The incidence of emetic sequelae did not increase and both patient satisfaction (p < 0.001) and sleep pattern (p < 0.05) in hospital were significantly improved. An estimate of the economic benefit suggests that the development of Acute Pain Services may be cost effective as well as providing an improved quality of service for patients undergoing surgery.     

Continuous subcutaneous infusion of morphine for postoperative pain relief

A double-blind randomised study of 48 patients in whom continuous subcutaneous infusion and regular intramuscular injection of morphine were compared as analgesic regimens after upper abdominal surgery, is described. Over a 48-hour period, no difference in pain intensity between the two groups was found by comparing linear analogue scores, assessments on a four-point rank scale, peak expiratory flow rates or requirement for additional analgesia. Nausea and sedation were assessed using a four-point rank scale. These side effects were less frequent with subcutaneous infusion (p less than 0.05). Two patients from each group were judged to have received an overdose. The infusion apparatus was simple and convenient to use. Continuous subcutaneous infusion of morphine is a practical and effective means of achieving post-operative analgesia but, as with other mandatory dosing regimens, relative overdosage may occur.     

国内大型综合医院和儿童医院小儿术后镇痛调查

目的了解当今国内小儿术后镇痛工作在儿童手术量较大的大型综合医院和儿童医院的应用情况,为小儿术后镇痛在国内推广应用提供参考。方法对全国预计小儿麻醉年手术量超过1000例的40家医院的麻醉科进行了问卷调查。31家医院完成调查,剔除年小儿手术量低于1000例的4家,纳入27家医院进行分析。调查的内容包括医院镇痛管理相关政策和制度,小儿术后镇痛开展情况,如开展镇痛的年龄段、常用术后镇痛方式和药物、静脉镇痛泵配方、小儿术后镇痛存在的问题等。结果纳入分析的医院中88．9％开展了小儿术后镇痛工作,开展1岁～3岁幼儿术后镇痛的占81．5％,1个月-12个月婴儿术后镇痛的占55．6％,新生儿术后镇痛仅有25．9％。超过80％的医院建立了小儿术后镇痛相关培训,并有个性化镇痛方案和疗效评估,但只有59．3％的医院安排有专门的小儿术后镇痛人员,22．2％设置了术后镇痛服务小组。所有开展小儿术后镇痛的医院均使用静脉患者自控镇痛（patient controlled analgesia,PCA）,只有25．9％医院开展硬膜外PCA方式镇痛。局麻药被广泛用于小儿术后镇痛,包括罗哌卡因、利多卡因和布比卡因,阿片类药物以舒芬太尼、芬太尼和曲马多为主,经常使用非甾体类抗炎药（non-steroid anti-inflammatory drugs,NSAIDs）的医院仅占29．6％,只有11．1％的医院经常使用对乙酰氨基酚。结论小儿术后镇痛工作在我国儿童手术较多的大型综合性医院和儿童医院已经普遍开展,但婴儿和新生儿的术后镇痛工作有待加强。有必要普及术后切口局麻药浸润,更多开展外周神经阻滞;普及副作用少又经济实用的对乙酰氨基酚类药物的使用,增加NSAIDs的用量,加强阿片类药物治疗安全的监控。