随机对照试验:评价吗啡对新生儿血浆肾上腺素/去甲肾上腺素浓度的影响

作     者：Simons S. H. P. Van Dijk M. Van Lingen R. A. D. Tibboel 郭战宏 

作者机构：Departm ent of Paediatric Surgery Erasmus MC-Sophia Dr Molewaterplein 60 3015 GJ Rotterdam NetherlandsDr. 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第5期

页      面：24-25页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：随机对照试验 去甲肾上腺素 血浆肾上腺素 神经肌肉阻断剂 安慰剂对照 脑室内出血 应激反应 机械通气 连续静脉滴注 剔除标准 

摘      要：Objectives: To determine the effects of continuous morphine infusion in ventil ated newborns on plasma concentrations of adrenaline (epinephrine) and noradrena line (norepinephrine)-and their relation to clinical outcome. Design: Blinded, randomised, placebo controlled trial. Setting: Level III neonatal intensive care units in two centres. Patients: A total of 126 ventilated neonates (inclusion c riteria: postnatal age 3 days, duration of ventilation 8 hours, indwelling a rterial catheter for clinical purposes; exclusion criteria: severe asphyxia, sev ere intraventricular haemorrhage, major congenital anomalies, neuromuscular bloc kers). Interventions: Plasma adrenaline and noradrenaline concentrations were de termined in patients during blinded morphine (n = 60) and placebo (n = 66) infus ion (100 μg/kg plus 10 μg/kg/h). Results: Plasma concentrations at baseline (n mol/l with interquartile range in parentheses) were comparable in infants treate d with morphine (adrenaline, 0.22 (0.31); noradrenaline, 2.52 (2.99)) or pla cebo (adrenaline, 0.29 (0.46); noradrenaline, 2.44 (3.14)). During infusion, median adrenaline concentrations were 0.12 (0.28) and 0.18 (0.35)-and medi an noradrenaline concentrations were 2.8 (3.7) and 3.8 (4.0) for the morphin e and placebo treated infants respectively. Multivariate analyses showed that no radrenaline (p = 0.029), but not adrenaline (p = 0.18), concentrations were si gnificantly lower in the morphine group than the placebo group. Furthermore, nor adrenaline concentrations were related to the length of stay in the neonatal int ensive care unit. Conclusions: Continuous morphine infusion significantly decrea sed plasma noradrenaline concentrations in ventilated newborns compared with pla cebo treatment. The results of this study support the idea that routine morphine administration decreases stress responses in ventilated neonates.