International Journal of Clinical Research
International Journal of Clinical Research. 2022; 6: (3) ; 10.12208/j.ijcr.20220089 .
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重庆医科大学附属儿童医院PICU，国家儿童健康与疾病临床医学研究中心 重庆
*通讯作者： 许峰,单位：重庆医科大学附属儿童医院PICU，国家儿童健康与疾病临床医学研究中心 重庆；
先天性心脏病（Congenital heart disease, CHD）是胎儿期心脏及大血管发育异常而致的先天畸形，是小儿最常见的心脏病。随着心脏外科技术的成熟和体外循环技术的发展，越来越多的先心患儿能够在婴幼儿期就得以手术矫正，从而极大改善先天性心脏病患儿的生存率和生活质量。但患儿术后的疼痛不容忽视，术后的疼痛对于患儿的神经、内分泌和代谢系统都有重大的影响，所以先天性心脏病患儿术后的镇静镇痛管理是非常重要的。镇静不足和镇静过度都是有害的，镇静不足会导致呼吸机对抗、机械通气无效、意外脱管等，而镇静过度又会导致呼吸抑制、低血压和药物依赖等。常用的小儿术后镇痛药大多为阿片类镇痛药，如舒芬太尼、吗啡、瑞芬太尼、芬太尼等药物，而氢吗啡酮作为吗啡的衍生物，已被证实在成人的术后的镇静镇痛具有镇痛效果强，安全性高的特点，但现应用于儿童术后镇痛的应用还比较局限，本文对儿童先天性心脏病术后使用氢吗啡酮作用的镇痛展开了探讨。
Congenital heart disease (CHD) is a congenital malformation caused by abnormal development of the heart and large blood vessels in the fetal period, and is the most common heart disease in children. With the maturity of cardiac surgery technology and the development of cardiopulmonary bypass technology, more and more children with congenital heart disease can be surgically corrected in infancy, thereby greatly improving the survival rate and quality of life of children with congenital heart disease. However, the postoperative pain of the child cannot be ignored, and the postoperative pain has a significant impact on the nerve, endocrine and metabolic systems of the child, so the postoperative sedation and analgesia management of children with congenital heart disease is very important. Inadequate sedation and hyperstation are both harmful, as inadequate sedation can lead to ventilator confrontation, ineffective mechanical ventilation, accidental de-tube, etc., while hyperstation can lead to respiratory depression, hypotension, and drug dependence. Most of the commonly used postoperative analgesics in children are opioid analgesics, such as sufentanil, morphine, remifentanil, fentanyl and other drugs, and hydromorphone as a derivative of morphine, has been confirmed to have a strong analgesic effect and high safety in adult postoperative sedation and analgesia, but the application of postoperative analgesia in children is still relatively limited, and this article discusses the analgesia of the use of hydromorphone after surgery for congenital heart disease in children.
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