摘要
目的:观察丙泊酚联合瑞芬太尼自控镇静镇痛在烧伤换药中应用的疗效及安全性。方法:106例Ⅱ度烧伤切痂植皮术后拟行首次换药患者按随机数字表法均分为试验组和对照组。试验组患者给予瑞芬太尼1 mg,加入2.5 ml丙泊酚中,取0.5 ml瑞芬太尼与丙泊酚的混合液,加入20 ml丙泊酚中,换药前90 s给予首次剂量3 ml,以后2 min/次,1 ml/次,静脉注射,随后开启注射泵,患者根据自身需求自控调整给药镇静镇痛;对照组患者换药前给予丙泊酚2.8 ml静脉注射,镇静效果不佳者可再次给予丙泊酚0.9 ml静脉注射。记录两组患者换药前、换药过程中各时点,换药毕静态疼痛视觉模拟(VAS)评分、Ramsay镇静评分及脉搏血氧饱和度(SpO2)、心率(HR)、收缩压(SBP)、舒张压(DBP)、呼吸频率(RR)的变化,并调查患者的满意率,观察不良反应情况。结果:两组患者换药过程中各时点及换药毕的VAS评分均显著低于同组换药前,Ramsay镇静评分均显著高于同组换药前;试验组患者除换药即刻外,其余各时间点VAS评分均显著低于对照组,Ramsay镇静评分均显著高于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组患者换药过程中各时点HR及换药开始后10 min SpO2、RR均显著低于同组换药前;试验组患者换药开始后10min SBP、DBP均显著低于对照组,差异均有统计学意义(P<0.05)。试验组患者满意率显著高于对照组,差异有统计学意义(P<0.01)。治疗期间所有患者均未见严重不良反应发生。结论:丙泊酚联合瑞芬太尼自控镇静镇痛对烧伤换药患者具有较好的镇静镇痛疗效,且安全性较好,满意率较高。
OBJECTIVE： To observe the application efficacy and safety of protocol combined with patient-controlled sedation and analgesia of remifentanil in dressing change for burn wound. METHODS： 106 cases of II degree bums, who received selective dressing change for the first time after escharectomy and dermatoplasty, were enrolled. According to random number table method, they were divided into trial group and control group. Trial group was given remifentanil 1 mg dissolved in 2.5 ml protocol, intravenous injection of 0.5 ml remifentanil and fontanel mixture dissolved in 20 ml protocol, with initial dose of 3 ml 90 s before dressing change, 1 ml each time. Lasting for 2 min per time, followed by injection pump of drugs, drug adjustment based on patient＇ s own demand. Control group was given intravenous injection of protocol 2.8 ml before dressing change, and then protocol 0.9 ml again because of unsatisfactory analgesia effect. The static visual analog pain score （VAS）, Ramsay sedation scores, and pulse oxygen saturatiola （SpO2）, heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, the change of respiratory frequency （RR）, satisfactory degree and ADR were recorded in 2 groups before dressing change, at different time points during dressing change, at the end of dressing change. RESULTS： VAS scores of 2 groups at different time points during dressing change and at the end of dressing change were significantly lower than before dressing change. Ramsay scores of 2 groups were significantly higher than before. The VAS scores of trial group were significantly lower than those of control group at each time point, except at dressing change. Ramsay sedation scores were significantly higher than in control group; there was statistical significance （P〈 0.05）; HR of 2 groups at different time points during dressing change, SpO2 and RR 10 min after dressing change were significantly lower than before; SBP and DBP 10 rain of trial group after dressing change were significantly lower than those of control group; there was statistical significance （P〈0.05）. The satisfactory degree of trial group was significantly higher than that of control group; there was statistical significance （P〈0.01）. No significant ADR was found during treatment. CONCLUSIONS： Protocol combined with patient-controlled sedation and analgesia of remifentanil shows sound sedation and analgesia effect on dressing change in bum patients, with sound safety and satisfactory degree.
出处
《中国药房》
CAS
CSCD
2014年第4期333-335,共3页
China Pharmacy
关键词
自控镇静镇痛
烧伤换药
丙泊酚
瑞芬太尼
Patient-controlled sedation and analgesia
Burn dressing
Propofol
Remifentanil
