Application of patient–controlled intravenous analgesia of dezocine combined with sufentanil in burn patients after surgery
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摘要: 目的 探讨地佐辛复合舒芬太尼用于烧伤患者切削痂自体皮移植术后静脉自控镇痛(PCIA)的效果和安全性。 方法 2011年2月—2013年12月,选择在笔者单位烧伤整形科住院治疗且符合入选标准的60例拟行切削痂自体皮移植术的患者,按照随机数字表法分为舒芬太尼组和地佐辛复合舒芬太尼组,每组30例。植皮术后,舒芬太尼组患者用含柠檬酸舒芬太尼2.5 μg/kg、托烷司琼6 mg的生理盐水150 mL持续镇痛48 h,地佐辛复合舒芬太尼组患者用含地佐辛0.25 mg/kg、柠檬酸舒芬太尼1.5 μg/kg、托烷司琼6 mg的生理盐水150 mL持续镇痛48 h。记录2组患者给药2、6、12、24、48 h视觉模拟评分(VAS)法镇痛评分、布氏舒适评分(BCS)法镇痛评分、Ramsay镇静评分结果,以及给药48 h内PCIA电子泵有效按压次数与不良反应发生情况。对数据行
t 检验、重复测量方差分析、χ 2检验、Fisher确切概率法检验。 结果 2组患者给药各时相点VAS法镇痛评分、BCS法镇痛评分比较,差异均无统计学意义(t 值为–0.426~0.864,P 值均大于0.05);舒芬太尼组患者给药2、6、12、24、48 h Ramsay镇静评分分别为(3.2±0.6)、(3.2±0.5)、(3.3±0.7)、(3.2±0.4)、(3.3±0.4)分,高于地佐辛复合舒芬太尼组的(2.4±0.6)、(2.5±0.5)、(2.4±0.6)、(2.4±0.4)、(2.4±0.5)分,t 值为5.302~8.391,P 值均小于0.001。舒芬太尼组、地佐辛复合舒芬太尼组患者给药48 h内PCIA电子泵有效按压次数分别为(6.8±0.7)、(6.5±0.9)次,组间比较差异无统计学意义(t =1.260,P >0.05)。2组患者给药48 h内均未出现呼吸抑制、皮肤瘙痒发生率相同、尿潴留发生率相近(P 值均大于0.05)。给药48 h内,舒芬太尼组、地佐辛复合舒芬太尼组患者恶心与呕吐发生率分别为26.7%(8/30)、6.7%(2/30),嗜睡发生率分别为20.0%(6/30)、0,组间比较差异均有统计学意义(P 值均小于0.05)。 结论 地佐辛复合舒芬太尼用于烧伤患者切削痂自体皮移植术后PCIA,镇痛效果可靠、不良反应少,可在临床推广应用。Abstract: Objective To evaluate the efficacy and safety of patient–controlled intravenous analgesia (PCIA) of dezocine combined with sufentanil in burn patients after escharectomy or tangential excision followed by autologous skin grafting. Methods Sixty burn patients hospitalized in Department of Burns and Plastic Surgery of our hospital from February 2011 to December 2013, conforming to the study criteria and going to have escharectomy or tangential excision followed by autologous skin grafting, were divided into sufentanil group (S,n =30) and dezocine+ sufentanil group (DS,n =30) according to the random number table. Patients in group S were given 150 mL normal saline containing 2.5 μg/kg sufentanil citrate and 6 mg tropisetron after skin grafting for 48 hours. Patients in group DS were given 150 mL normal saline containing 0.25 mg/kg dezocine, 1.5 μg/kg sufentanil citrate, and 6 mg tropisetron for 48 hours. Visual Analog Scale (VAS), Bruggrmann Comfort Scale (BCS), and Ramsay Sedation Scale were used to evaluate the sedative effect or analgesic effect, and their scores were recorded at administration hour (AH) 2, 6, 12, 24, and 48. The times of efficient injection and incidence of adverse effect within the 48 AH were recorded. Data were processed with analysis of variance for repeated measurement,t test, chi–square test, and Fisher′s exact test. Results There were no obvious differences in the scores of VAS and BCS between two groups at each time point (witht values from –0.426 to 0.864,P values above 0.05). The scores of Ramsay Sedation Scale in group S at AH 2, 6, 12, 24, and 48 were respectively (3.2±0.6), (3.2±0.5), (3.3±0.7), (3.2±0.4), and (3.3±0.4) points, which were higher than those in group DS [(2.4±0.6), (2.5±0.5), (2.4±0.6), (2.4±0.4), and (2.4±0.5) points, witht values from 5.302 to 8.391,P values below 0.001]. The times of efficient injection within the 48 AH was 6.8±0.7 in group S and 6.5±0.9 in group DS, showing no significantly statistical difference (t =1.260,P >0.05). Respiratory depression was not observed in both groups; the incidence of pruritus was the same, and that of urine retention was similar between the 2 groups within the 48 AH (withP values above 0.05). Within the 48 AH, the incidence of nausea and vomiting in group S was 26.7% (8/30), which was obviously higher than that in group DS (6.7%, 2/30,P <0.05); the incidence of drowsiness in group S was 20.0% (6/30), which was significantly higher than that in group DS (no patient,P <0.05). Conclusions Dezocine combined with sufentanil can provide effective postoperative analgesia with little adverse effect for PCIA in burn patients after escharectomy or tangential excision followed by autologous skin grafting, therefore it can be widely used.-
Key words:
- Burns /
- Sufentanil /
- Analgesia, patient–controlled /
- Dezocine
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