Current status and research advances on drug sedation and analgesia in burn children
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摘要: 儿童是烧伤的高发人群，具有独特的生理、心理和解剖状态，对烧伤儿童的焦虑和疼痛管理极具挑战。非药物干预在烧伤儿童的疼痛管理中很重要，但通常不足以充分治疗疼痛和焦虑，因此药物镇静镇痛是必需的。本综述回顾了该领域国内外近10年来临床治疗及科研进展，包括对烧伤儿童的疼痛评估，镇静镇痛治疗中的监护、主要的治疗药物及研究进展、临床实践中的一些争议，并提出一些建议，以供临床参考。Abstract: Children are high-risk groups of burns, with unique physiological, psychological, and anatomical states, and the management of anxiety and pain for burn children are extremely challenging. Non-pharmacological interventions are very important for pain management in burn children, but are often inadequate for treating pain and anxiety, so pharmacological sedation and analgesia are necessary. This article reviewed the clinical treatment and research progress in this field in the past 10 years at home and abroad, including the pain assessment of burn children, monitoring in sedative and analgesic treatment, main therapeutic drugs and research progress, and some controversies in clinical practice. Besides, some suggestions have been put forward for clinical reference.
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Key words:
- Burns /
- Child /
- Pain /
- Sedation and analgesia /
- Drug intervention
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参考文献
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表1 烧伤儿童常用的部分镇静药物及其拮抗药物的使用情况和注意事项
药物分类及名称 用药方法及剂量 起效时间（min） 效果持续时间（min） 注意事项 苯二氮卓类 咪达唑仑 静脉推注：0.5~5岁初始剂量为0.05~0.1 mg/kg，然后滴定至最大剂量0.6 mg/kg；6~12岁初始剂量为0.025~0.05 mg/kg，然后滴定至最大剂量0.40 mg/kg 2~3 45~60 与阿片类药物合用时减少剂量 肌内注射：每次0.10~0.15 mg/kg 10~20 60~120 口服：每次0.5~0.75 mg/kg 15~30 60~90 滴鼻：每次0.2~0.5 mg/kg 10~15 60 直肠给药：每次0.25~0.5 mg/kg 10~30 60~90 地西泮 静脉推注：初始剂量0.05~0.1 mg/kg，然后慢慢滴定至最大剂量0.25 mg/kg 4~5 60~120 与阿片类药物合用时减少剂量 苯二氮卓类拮抗药 氟马西尼 静脉推注：每次0.02 mg/kg，根据需要可每分钟重复给药1次，总剂量最多1 mg 1~2 30~60 如作用时间短于所拮抗的药物，则可能需要连续给药 α2肾上腺素能激动剂 右美托咪定 静脉推注：初始剂量0.3~1 μg/kg，推注时间10~15 min，随后以0.1~0.6 μg·kg-1·h-1的剂量滴注 10~15 — 与扩血管药物、负性频率药物同时使用时应谨慎，避免突然停药，最长给药时间24 h 水合氯醛 口服：每次25~100 mg/kg，30 min后可重复给药25~50 mg/kg，总剂量最多2 g或100 mg/kg（以较少者为准） 15~30 60~120 禁止与呋塞米同时使用 丙泊酚 静脉推注：初始剂量1.0 mg/kg，然后可根据需要按照0.5 mg/kg剂量重复给药 <1 5~15 鸡蛋或蛋制品及大豆或豆制品过敏者避免使用 注：该表引自文献[6,12, 13, 14]，“—”表示维持剂量可持续起效；药品的使用说明及禁忌证、不良反应详见药品说明书 
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表2 烧伤儿童常用的部分镇痛药物及其拮抗药物的使用情况和注意事项
药物分类及名称 用药方法及剂量 起效时间（min） 效果持续时间（min） 注意事项 阿片类 芬太尼 静脉推注：每次1.0 g/kg（最多不超过50 g），可每3分钟重复给药1次 3~5 30~60 与苯二氮卓类药物合用时减少剂量 吗啡 静脉推注：每次0.05~0.15 mg/kg（最多不超过3 mg），可每5分钟重复给药1次 5~10 120~180 与苯二氮卓类药物合用时减少剂量 阿片类拮抗药 纳洛酮 静脉推注或肌内注射：每次0.1 mg，每次最多2 mg，根据需要每2分钟重复1次 静脉推注：2 静脉推注：20~40，肌内注射：60~90 如作用时间短于所拮抗的药物，则可能需要连续给药 解离性药物 氯胺酮 静脉推注：1~1.5 mg/kg，推注时间>1 min，根据需要每10分钟重复1次；肌内注射：初始剂量45 mg/kg，10 min后可按2~4 mg/kg重复给药 1 静脉推注：5~10，肌内注射：12~25 对血压升高会造成危险的患者禁用，休克失代偿期、心功能不全的患者禁用，给药前后24 h禁酒 3~5 吸入药物 一氧化二氮 含至少体积分数30%氧气的混合物，持续面罩供给（不合作儿童使用鼻罩供给） <5 停药后<5 需要专门的气体供应设备和气体清除设备 非甾体类抗炎药 布洛芬 口服或直肠给药：15 mg/kg — — 心脏手术前后禁用，过敏者禁用 对乙酰氨基酚 口服或直肠给药：15~20 mg/kg，静脉推注：不超过100 mg·kg-1·d-1 — — 12岁以下不推荐使用，肝肾功不全及过敏体质者慎用，禁止与乙醇及含乙醇的饮料同时使用 注：该表引自文献[6,12, 13, 14]，“—”表示文献中未提到；文献中未提到肌内注射纳洛酮的起效时间；药品的使用说明及禁忌证、不良反应详见药品说明书
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