新生儿重症监护病房吗啡的使用和不良反应。

D A Tholl, M S Wager, C H Sajous, T F Myers
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摘要

在新生儿重症监护病房(NICU)吗啡使用的处方模式和适当性评估在并发药物使用评估(DUE)。研究人员收集了99名在6个月内接受吗啡治疗的婴儿的数据。回顾患者病历,收集以下数据:患者的年龄、体重、给药计划、同时使用的镇静剂、通气状态、是否记录充足的镇痛以及药物不良反应(adr)的描述。审查医生的医嘱,以确定是否遵守新生儿重症监护病房吗啡剂量指南,是否注意到使用指征。6例患者发生7例不良反应;3例不良反应发生在眼部冷冻手术后。285份医嘱中有79份(27.7%)注明了使用适应症。在360个患者日中,有60个(16.7%)记录了镇静或镇痛的充分性。DUE结果引起了一些变化:医生被要求从计算机订单输入系统的列表中选择适应症,在护理流程表中增加了镇痛或镇静评估量表,并且在眼科冷冻手术前需要气管插管。随访的DUE显示几乎完全遵守了新的吗啡使用指南,并且吗啡不良反应的数量有所减少。DUE促使政策改变,改进了对吗啡使用适应症和疗效的记录,减少了新生儿重症监护室对吗啡的不良反应。
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Morphine use and adverse effects in a neonatal intensive care unit.

Prescribing patterns and appropriateness of morphine use in a neonatal intensive care unit (NICU) were evaluated in a concurrent drug-use evaluation (DUE). Data were collected for 99 infants who received morphine over a six-month period. Patient charts were reviewed to collect the following data: patient's age, weight, dosage schedule, concurrent sedatives, ventilatory status, whether adequacy of analgesia was documented, and descriptions of adverse drug reactions (ADRs). The physicians' orders were reviewed to determine whether NICU morphine dosage guidelines were followed and whether the indication for use was noted. Seven ADRs occurred in six of the patients; three of the ADRs occurred after ophthalmic cryosurgery. Indications for use were noted in 79 of 285 physician orders (27.7%). The adequacy of sedation or analgesia was documented on 60 of the 360 patient days (16.7%). The DUE results prompted several changes: physicians were asked to select indications from a list in the computerized order-entry system, an analgesia or sedation assessment scale was added to nursing flow sheets, and endotracheal intubation became a requirement before ophthalmic cryosurgery. A follow-up DUE showed nearly complete compliance with the new guidelines for morphine use and a reduction in the number of adverse reactions to morphine. A DUE prompted policy changes that improved documentation of indications for and efficacy of morphine use and reduced adverse reactions to the drug in an NICU.

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