Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

Han Dawei; Yang Huanna; Li Yancang; Wei Ying; Tian Shemin; Xia Chengde; Li Xiaoliang

doi:10.3760/cma.j.cn501120-20211008-00347

Volume 38 Issue 1

Jan. 2022

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2022 > 38(1): 38-44

Yu Meirong, Guo Songxue, Jin Ronghua, et al. Effect and mechanism of astaxanthin on acute kidney injury in rats with full-thickness burns[J]. Chin j Burns, 2020, 36(11): 1050-1059. Doi: 10.3760/cma.j.cn501120-20200526-00287

Citation:

Han DW,Yang HN,Li YC,et al.Effects of continuous goal-directed analgesia on fluid resusof massive burn patients during shock[J].Chin J Burns Wounds,2022,38(1):38-44.DOI: 10.3760/cma.j.cn501120-20211008-00347.

Citation:

PDF( 732 KB)

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

doi: 10.3760/cma.j.cn501120-20211008-00347

Department of Burns, Zhengzhou First People's Hospital, Zhengzhou 450004, China

Funds:

Medical Science Research Projects of Henan Province LHGJ20191002, LHGJ20200700, LHGJ20210714

More Information

Corresponding author: Li Xiaoliang, Email: steven0204121@126.com
Received Date: 2021-10-08

Abstract

Abstract

Objective To investigate the effects of continuous goal-directed analgesia on fluid resuscitation during shock stage in patients with massive burns, providing a basis for rational optimization of analgesia protocols in patients with burn shock. Methods A retrospective case series study was conducted. One hundred and thirty-six patients with massive burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital from January 2015 to December 2020, and the patients were divided into continuous analgesia (CA) group (68 cases,with average age of 44 years old) and intermittent analgesia (IA) group (68 cases,with average age of 45 years old) according to whether sufentanil injection was continuously used for intravenous analgesia during the shock stage. The patients in the 2 groups were predominantly male. Before and at 72 h of treatment, the severity of disease and trauma pain of patients in the 2 groups were scored by the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and the visual analogue scale (VAS). Hematocrit, heart rate, mean arterial pressure (MAP), central venous pressure (CVP), oxygen saturation in central venous blood (ScvO ₂), rehydration coefficient, blood lactate value, hourly urine output, and the adverse reactions such as hypotension, nausea, vomiting, dizziness, skeletal muscle tonicity, respiratory depression, bradycardia, pruritus, and drug addiction of patients in the 2 groups during the treatment were recorded at the 1 ^st, 2 ^nd, and 3 ^rd 24 h post-injury. Data were statistically analyzed with analysis of variance for repeated measurement, paired or independent sample t test, Bonferroni correction,chi-square test and Mann-Whitney U test. Results Before treatment, APACHE Ⅱ and VAS scores of patients in the 2 groups were close (with tvalues of -0.67 and 0.32, respectively, P>0.05); At 72 h of treatment, APACHE Ⅱ and VAS scores of patients in CA group were 8.5±2.2 and 2.5±1.6, both of which were significantly lower than (15.2±3.0) and (7.9±2.0) of patients in IA group, respectively (with t values of -14.94 and -17.46, respectively, P<0.01). Compared with the pre-treatment period, the APACHE Ⅱ and VAS scores of patients in IA group decreased significantly at 72 h of treatment (with tvalues of 11.35 and 30.59, respectively, P<0.01); the changes in APACHE Ⅱ and VAS scores of patients at 72 h of treatment in comparison with those of patients before treatment in CA group were all similar to those of patients in IA group (with t values of 4.00 and 4.82, respectively, P<0.01). Compared with those of patients in IA group, there were no significant changes in CVP, hematocrit, heart rate, ScvO ₂, and MAP of patients in CA group at all three 24 h post-injury (with tvalues of <0.01, 0.12, 2.10, 1.55, 0.03; 0.13, 0.22, <0.01, 0.17, 0.49; 0.63, 0.06, 0.04, 2.79, and 2.33, respectively, P>0.05). Compared with those of patients in IA group at the 1 ^st 24 h post-injury, CVP, ScvO ₂ and MAP of patients were significantly higher at the 2 ^nd and 3 ^rd 24 h post-injury (with t values of -10.10, -9.31, -8.89; -10.81, -4.65, and -9.43, respectively, P<0.01), and the heart rate of patients was significantly lower at the 2 ^nd and 3 ^rd 24 h post-injury (with t values of 7.53 and 7.78, respectively, P<0.01), and the hematocrit of patients decreased significantly only at the 3 ^rd 24 h post-injury ( t=15.55, P<0.01); the changes of CVP, ScvO ₂, MAP and heart rate of patients at the 2 ^nd and the 3 ^rd 24 h post-injury, and HCT of patients at the 3 ^rd 24 h post-injury, in comparison with those of patients at the 1 ^st 24 h post-injury in CA group were similar to those of patients in IA group (with t values of -12.25, -10.24, -8.99, 9.42, -8.83, -7.53, -11.57, 10.44, and 12.91, respectively, P<0.01). Compared with those of patients in IA group, the rehydration coefficient of patients in CA group was significantly higher only at the 3 ^rd 24 h post-injury ( t=5.60, P<0.05), blood lactate value of patients in CA group was significantly lower at the 1 ^st and 2 ^nd 24 h post-injury (with t values of 4.32 and 14.52, respectively, P<0.05 or P<0.01), the hourly urine output of patients in CA group increased significantly at the 1 ^st, 2 ^nd, and 3 ^rd 24 h post-injury (with t values of 24.65, 13.12, and 5.63, respectively, P<0.05 or P<0.01). Compared with the those of patients at the 1 ^st 24 h post-injury, the rehydration coefficient of patients in IA group decreased significantly at the 2 ^nd and the 3 ^rd 24 h post-injury (with t values of 33.98 and 36.91, respectively, P<0.01), the blood lactate values of patients in IA group decreased significantly at the 2 ^nd and the 3 ^rd 24 h post-injury (with t values of 8.20 and 11.68, respectively, P<0.01), and the hourly urine output of patients in IA group was significantly increased at the 2 ^nd and the 3 ^rd 24 h post-injury (with t values of -3.52 and -5.92, respectively, P<0.01); the changes of rehydration coefficients and blood lactate values of patients at the 2 ^nd and the 3 ^rd 24 h post-injury in comparison with those of patients at the 1 ^st 24 h post-injury in CA group were similar to those of patients in IA group (with tvalues of 35.64, 33.64, 9.86, and 12.56, respectively, P<0.01), but hourly urine output of patients in CA group increased significantly only at the 3 ^rd 24 h compared with that of patients at the 1 ^st 24 h post-injury ( t=-3.07, P<0.01). Adverse reactions such as hypotension, nausea, vomiting, dizziness, bradycardia, and pruritus occurred rarely in patients of the 2 groups, and none of the patients had skeletal muscle tonicity, respiratory depression, or drug addiction. The incidence of adverse reactions of patients in CA group was similar to that in IA group ( χ ²=0.08, P>0.05). Conclusions Continuous goal-directed analgesia can effectively relieve pain and improve vital signs of patients with large burns. Meanwhile it has little impact on volume load, which can assist in correcting ischemia and hypoxia during the shock period and help patients get through the shock period smoothly.
- Burns,
- Shock,
- Pain,
- Goal-directed analgesia,
- Fluid resuscitation

FullText(HTML)

References(26)

References

[1]	种丽双,王震生,韩紫娜,等.不同剂量瑞芬太尼对妇科腹腔镜术后患者痛觉过敏的影响[J].中国医师进修杂志,2015,38(3):185-188.DOI: 10.3760/cma.j.issn.1673-4904.2015.03.009.
[2]	周扬,谢创波,屠伟峰.重视围术期目标导向全程镇痛推广与普及[J].麻醉安全与质控,2017,1(2):55-59.
[3]	夏建国,肖红,张佳,等.烧伤患者休克期静脉注射氯胺酮和芬太尼镇痛的可行性观察[J].中华烧伤杂志,2004,20(5):307.DOI: 10.3760/cma.j.issn.1009-2587.2004.05.026.
[4]	王志斌,伊敬东,徐凯智.舒芬太尼对全麻老年患者苏醒期镇痛效果及血流动力学的影响[J].中国综合临床,2013, 29(1):100-103. DOI: 10.3760/cma.j.issn.1008-6315.2013.01.032.
[5]	王鹏,石墩义,马伟,等.限制性液体复苏联合舒芬太尼对创伤失血性休克患者院前急救的影响[J].检验医学与临床,2016,13(5):614-616.DOI: 10.3969/j.issn.1672-9455.2016.05.015.
[6]	罗高兴,彭毅志,庄颖,等.烧伤休克期有关补液公式的临床应用与评价[J].中华烧伤杂志,2008,24(4):248-250.DOI: 10.3760/cma.j.issn.1009-2587.2008.04.003.
[7]	HalgasB,BayC,FosterK.A comparison of injury scoring systems in predicting burn mortality[J].Ann Burns Fire Disasters,2018,31(2):89-93.
[8]	GandhiM, ThomsonC, LordD, et al. Management of pain in children with burns[J]. Int J Pediatr,2010,2010:825657. DOI: 10.1155/2010/825657.
[9]	JamesDL, JowzaM. Principles of burn pain management[J]. Clin Plast Surg,2017,44(4):737-747. DOI: 10.1016/j.cps.2017.05.005.
[10]	DevlinJW,SkrobikY,GélinasC,et al.Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU[J].Crit Care Med,2018,46(9):1532-1548.DOI: 10.1097/CCM.0000000000003259.
[11]	WallSL,ClarkeDL,AllortoNL.Analgesia protocols for burns dressings: challenges with implementation[J].Burns,2019,45(7):1680-1684.DOI: 10.1016/j.burns.2019.04.012.
[12]	VincentJL, SakrY, SprungCL, et al. Sepsis occurrence in acutely ill patients investigators. sepsis in european intensive care units: results of the SOAP study[J]. Crit Care Med, 2006,34(2):344-353. DOI: 10.1097/01.ccm.0000194725.48928.3a.
[13]	MorelJ,SalardM,CastelainC,et al.Haemodynamic consequences of etomidate administration in elective cardiac surgery: a randomized double-blinded study[J].Br J Anaesth,2011,107(4):503-509.DOI: 10.1093/bja/aer169.
[14]	GillespieRS,SeidelK,SymonsJM.Effect of fluid overload and dose of replacement fluid on survival in hemofiltration[J].Pediatr Nephrol,2004,19(12):1394-1399.DOI: 10.1007/s00467-004-1655-1.
[15]	张奕威,苏月南,陈咏佳.慢性阻塞性肺疾病需机械通气患者NT-proBNP水平与APACHEⅡ评分相关性临床分析[J].中国实用医刊,2013,40(16):9-11.DOI: 10.3760/cma.j.issn.1674-4756.2013.16.005.
[16]	于洋,李青栋.烧伤休克患者的血流动力学特点及目标导向性镇痛研究进展[J].中华烧伤杂志,2018,34(5):318-320.DOI: 10.3760/cma.j.issn.1009-2587.2018.05.015.
[17]	王志勇,冯世海,范宝莉,等.导向性限制性液体管理策略对严重烧伤合并重度吸入性损伤患者的影响[J].中华烧伤杂志,2019,35(7):501-506.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.005.
[18]	KelmDJ,PerrinJT,Cartin-CebaR,et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death[J]. Shock, 2015, 43(1):68-73. DOI: 10.1097/SHK.0000000000000268.
[19]	BouchardJ,SorokoSB,ChertowGM,et al.Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury[J].Kidney Int,2009,76(4):422-427.DOI: 10.1038/ki.2009.159.
[20]	佘明金,朱文博.大剂量舒芬太尼患者自控镇痛治疗难治性癌痛合并爆发痛:一例报道与文献复习[J].中华疼痛学杂志,2021,17(5):543-546.DOI: 10.3760/cma.j.cn101379-20191226-00108.
[21]	花嵘,杨永圣,姚爱明,等.强化镇痛对急性创伤患者创伤后应激障碍发病的影响[J].中华急诊医学杂志,2021,30(2):217-220.DOI: 10.3760/cma.j.issn.1671-0282.2021.02.015.
[22]	BarrJ,FraserGL,PuntilloK,et al.Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.DOI: 10.1097/CCM.0b013e3182783b72.
[23]	李如兵,陈茜,张红艳,等.重症烧伤患者休克期镇痛镇静治疗安全性及疗效观察[J].中华烧伤杂志,2018,34(4):197-202.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.002.
[24]	郭鹏,刘菊,王刚,等.纳布啡复合舒芬太尼不同剂量组合用于腹式子宫切除术后镇痛的观察[J].中国医师进修杂志,2019,42(7):603-607.DOI: 10.3760/cma.j.issn.1673-4904.2019.07.008.
[25]	SchugSA,TingS.Fentanyl formulations in the management of pain: an update[J].Drugs,2017,77(7):747-763.DOI: 10.1007/s40265-017-0727-z.
[26]	李一,周军利.脉搏轮廓心排血量监测技术在大面积烧伤患者中的应用研究进展[J].中华烧伤杂志,2018,34(10):737-740.DOI: 10.3760/cma.j.issn.1009-2587.2018.10.018.

Relative Articles

[1]	Heng Xue, Li Changmin, Liu Wei, Li Ning, Yuan Zhiqiang, Peng Yizhi, Li Haisheng, Luo Gaoxing. Analysis of effects and influencing factors of continuous renal replacement therapy in severe burn patients complicated with acute kidney injury[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(5): 468-475. doi: 10.3760/cma.j.cn501225-20240207-00052
[2]	Li Jingyan, Yao Yongming, Tian Yingping. Early predictive value of high density lipoprotein cholesterol for secondary acute kidney injury in sepsis patients[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(2): 130-136. doi: 10.3760/cma.j.cn501120-20210917-00325
[3]	Lou Jiaqi, Li Ye, Cui Qingwei, Zhang Pan, Sun Han, Tang Hao, Zhuang Mengmeng, Sun Yong. A prospectively randomized controlled study of the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(9): 821-830. doi: 10.3760/cma.j.cn501120-20210428-00159
[4]	Li Xiaoliang, Ye Xiangyang, Li Yanguang, Xiao Hongtao, Zhao Xiaokai, Zhang Jian, Feng Ke, Tian Shemin, Lou Jihe, Xia Chengde. Value of renal injury marker protein in early diagnosis of acute kidney injury in burn patients with delayed resuscitation[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(2): 143-149. doi: 10.3760/cma.j.cn501120-20200915-00411
[5]	Jiang Bin, Shen Mingyan, Shen Tao. Nursing of one patient with extremely severe burn-blast combined injury complicated with acute kidney injury caused by dust explosion[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(7): 603-605. doi: 10.3760/cma.j.cn501120-20190415-00188
[6]	Zhang Ying, Xu Gang, Luo Yi, Jin Junjun. Early debridement combined with antidote in the treatment of one patient with chromic acid burn and acute kidney injury[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(10): 969-970. doi: 10.3760/cma.j.cn501120-20190813-00349
[7]	Fang He, Xu Long, Zhu Feng. Advances in the research of persistent inflammation-immunosuppression-catabolism syndrome in severe burn[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2019, 35(7): 548-551. doi: 10.3760/cma.j.issn.1009-2587.2019.07.015
[8]	Li Xiaoliang, Xiao Hongtao, Li Yancang, Li Yanguang, Zhang Jian, Feng Ke, Di Haiping, Tian Shemin, Lou Jihe, Xia Chengde. Effects of citric acid on patients with severe burn complicated with acute renal injury treated by continuous renal replacement therapy[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2019, 35(8): 568-573. doi: 10.3760/cma.j.issn.1009-2587.2019.08.003
[9]	Liu Wei, Chai Jiake. Influences of ulinastatin on acute lung injury and time phase changes of coagulation parameters in rats with burn-blast combined injuries[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(1): 32-39. doi: 10.3760/cma.j.issn.1009-2587.2018.01.007
[10]	Li Hushan, Yang Xuekang, Hao Zhenming, Lei Jin. Interventional effects of BAY11-7082 on lung inflammatory response at the early stage and acute lung injury of rats with severe burns[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(2): 88-95. doi: 10.3760/cma.j.issn.1009-2587.2018.02.006
[11]	Wang Lili, Guo Songxue, Wu Pan, Shao Huawei, Han Chunmao. Influences of hydrogen-rich saline on acute kidney injury in severely burned rats and mechanism[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(9): 629-636. doi: 10.3760/cma.j.issn.1009-2587.2018.09.013
[12]	Tang Chenqi, Li Junqiang, Xu Dayuan, Liu Xiaobin, Hou Wenjia, Lyu Kaiyang, Xiao Shichu, Xia Zhaofan. Comparison of machine learning method and logistic regression model in prediction of acute kidney injury in severely burned patients[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(6): 343-348. doi: 10.3760/cma.j.issn.1009-2587.2018.06.006
[13]	Yuan Zhiqiang, Peng Yizhi. Attaching importance to sepsis-induced acute kidney injury after burn[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(2): 69-72. doi: 10.3760/cma.j.issn.1009-2587.2018.02.002
[14]	Guo Songxue, Zhou Hanlei, You Chuangang, Han Chunmao. Advances in the research of acute kidney injury post burn[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(8): 508-511. doi: 10.3760/cma.j.issn.1009-2587.2016.08.017
[15]	Feng Shihai, Liu Qun, Ma Wei, Jia Xiangcheng, Xie Yugang. Clinical observation on the treatment of phenol burn patients complicated by acute kidney injury with early blood purification[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2015, 31(6): 416-420. doi: 10.3760/cma.j.issn.1009-2587.2015.06.005
[17]	Wang Yihe, Yang Hongming, Hu Quan, Hou Yusen, Luo Hongmin, Liu Lingying. Effects of sivelestat on acute lung injury in dogs with severe burn-blast combined injury Wang Yihe,[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2014, 30(2): 158-165. doi: 10.3760/cma.j.issn.1009-2587.2014.02.015

Supplements(0)

Cited By

Cited by

Periodical cited type(3)

1.	黄薛亮. 虾青素在肾相关疾病中的研究进展. 国际泌尿系统杂志. 2024(03): 563-566 .
2.	李聪颖，赵学刚，郝嘉文，盖晨阳，鲁梦远，张晶，张庆富，冯建科，屠丽红. 高压电烧伤大鼠肾脏氧化应激损伤的特点及灯盏花素的干预作用. 中华烧伤与创面修复杂志. 2024(08): 746-755 . 本站查看
3.	姜新根，孙赫，赵金花. 三黄跌打膏外敷对大鼠急性软组织损伤的疗效. 中国药物经济学. 2022(07): 90-92+96 .

Other cited types(3)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Tables(4)

Get Citation

PDF

XML

Article Metrics

Article views (352) PDF downloads(44)

Effects of continuous goal-directed analgesia on fluid resuscitation of massive burn patients during shock

doi: 10.3760/cma.j.cn501120-20211008-00347