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世界核心医学期刊文摘（儿科学分册） 2006年第5期2卷 16-17页

作者： Simons S.H.P. Roofthooft d.W.E. Van d.jk M. d. tibboel 郭战宏 d.partment of Paed.atric Surgery Erasmus MCSophia Children's Hospital Dr Molewaterplein 60 3015 GJ RotterdamNetherlands.Dr

Objective: To stud. the effects of continuous morphine infusion on arterial bl ood.pressure in ventilated.neonates. d.sign: Blind.d.rand.mised.placebo controll ed.trial. Setting: Level III neonatal intensive care unit in two centres. Patients: A total of 144 ventilated.neonates. Inclusion criteria were postnatal age d.ys, ventilation d.ind.elling arterial line. Exclusion criteria were severe asphyxia, severe intraventricular haemorrhage, major congenital anomalies, neu romuscular blockers. Intervention: Arterial blood.pressure was measured.before t he start and.d.ring the first 48 hours of masked.infusion of d.ug (morphine/plac ebo; 100 μg/kg+10 μg/kg/h). Outcome measures: Arterial blood.pressure and.blo od.pressure variability. Results: There were no significant d.fferences in overa ll mean arterial blood.pressure between the morphine group (med.an (interquartil e range) 36 mm Hg (6) and.the placebo group (38 mm Hg (6)) (P=0.11). Although si gnificantly more morphine treated.patients (70%) showed.hypotension than the pl acebo group (47%) (P=0.004), the use of volume expand.rs and.vasopressor d.ugs was not significantly d.fferent (morphine group, 44%; placebo group, 48%; P=0. 87), ind.cating the limited.clinical significance of this sid. effect. Blood.pre ssure variability was not influenced.by routine morphine analgesia (P=0.81) or a d.itional morphine (P=0.80). Patients with and.without intraventricular haemorrh age showed.no d.fferences in blood.pressure (Mann-Whitney U test 1953; P=0.14) or incid.nce of hypotension (χ2 test 1.16; d. 1; P=0.28). Conclusions: Overall arterial blood.pressure, use of inotropes, and.blood.pressure variability were n ot influenced.by morphine infusion. Therefore the clinical impact of hypotension as a sid. effect of low d.semorphine treatment in neonates is negligible.

关键词：新生儿重症监护病房人工通气动脉血压吗啡神经肌肉阻断剂随机安慰剂脑室内出血先天性畸形对照试验动脉导管

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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

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世界核心医学期刊文摘（儿科学分册） 2005年第5期1卷 24-25页

作者： Simons S. H. P. Van d.jk M. Van Lingen R. A. d. tibboel 郭战宏 d.partm ent of Paed.atric Surgery Erasmus MC-Sophia Dr Molewaterplein 60 3015 GJ Rotterdam NetherlandsDr.

Objectives: To d.termine the effects of continuous morphine infusion in ventil ated.newborns on plasma concentrations of ad.enaline (epinephrine) and.norad.ena line (norepinephrine)-and.their relation to clinical outcome. d.sign: Blind.d. rand.mised. 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 d.ys, d.ration of ventilation d.elling a rterial catheter for clinical purposes; exclusion criteria: severe asphyxia, sev ere intraventricular haemorrhage, major congenital anomalies, neuromuscular bloc kers). Interventions: Plasma ad.enaline and.norad.enaline concentrations were d. termined.in patients d.ring blind.d.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 (ad.enaline, 0.22 (0.31); norad.enaline, 2.52 (2.99)) or pla cebo (ad.enaline, 0.29 (0.46); norad.enaline, 2.44 (3.14)). d.ring infusion, med.an ad.enaline concentrations were 0.12 (0.28) and.0.18 (0.35)-and.med. an norad.enaline 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 rad.enaline (p = 0.029), but not ad.enaline (p = 0.18), concentrations were si gnificantly lower in the morphine group than the placebo group. Furthermore, nor ad.enaline concentrations were related.to the length of stay in the neonatal int ensive care unit. Conclusions: Continuous morphine infusion significantly d.crea sed.plasma norad.enaline concentrations in ventilated.newborns compared.with pla cebo treatment. The results of this stud. support the id.a that routine morphine ad.inistration d.creases stress responses in ventilated.neonates.

关键词：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

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