右美托咪定对舒芬太尼用于小儿大面积烧伤削痂植皮术后镇痛的改良作用  

Efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting

作　　者：郝雪莲[1] 孙媛[1] 郭琼梅[1] 王欣[1] 赵恒娣[1] 周晓辉[1] 王莉[1] 

机构地区：[1]河北医科大学第一医院麻醉科,050031

出　　处：《中华麻醉学杂志》2016年第4期456-458,共3页Chinese Journal of Anesthesiology

基　　金：河北省医学科学研究重点课题（20150633）

摘　　要：目的评价右美托咪定对舒芬太尼用于小儿大面积烧伤削痂植皮术后镇痛的改良作用。方法大面积烧伤小儿42例，ASA分级Ⅱ或Ⅲ级，年龄2～10岁，体重13～36kg，性别不限，在丙泊酚一瑞芬太尼一七氟醚复合全麻下行大面积烧伤削痂植皮术。采用随机数字表法分为2组（n=21）：舒芬太尼组（Suf组）和右美托咪定＋舒芬太尼组（Dex—Suf组）。术后给予病人控制静脉镇痛，Suf组配方为舒芬太尼2μg／kg＋格拉司琼100μg／kg；Dex—Suf组配方为右美托咪定2．5μg／kg＋舒芬太尼1．5μg／kg＋格拉司琼100μg／kg，均加生理盐水混合至100ml。静脉注射负荷量舒芬太尼0．1μg／kg，背景输注速率2ml／h，PCA剂量0．5ml，锁定时间15min。脸谱疼痛评分〉2分时，静脉注射舒芬太尼0．1μg／kg进行补救镇痛。记录术后48h舒芬太尼用量、静态和动态（换药时）Ramsay镇静评分、家长满意度评分、补救镇痛及恶心呕吐等不良反应的发生情况。结果与Suf组比较，Dex—Suf组术后静态和动态时患儿Ramsay镇静评分和家长满意度评分升高，舒芬太尼用量、补救镇痛率、躁动、恶心呕吐发生率降低（P〈0．05）。结论右美托咪定对舒芬太尼用于小儿大面积烧伤削痂植皮术后静脉镇痛具有明显的改良作用，此类患儿推荐采用右美托咪定一舒芬太尼复合用药。Objective To evaluate the efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting. Methods Forty-two pediatric patients of both sexes with a large area of burn, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , aged 2-10 yr, weighing 13-36 kg, scheduled for elective tangential excision and skin grafting under combined propofol-remifentanil-sevoflurane anesthesia, were randomly divided into 2 groups （n = 21 each） using a random number table： sufentanil group （group Suf） and dexmedetomidine plus sufentanil group （group Dex-Suf）. The patient-controlled intravenous analgesia （PCIA） was used for postoperative analgesia. PCIA solution contained sufentanil 2 μg/kg and granisetron 100 μg/kg in 100 ml of normal saline in group Suf, and contained dexmedetomidine 2.5 btg/kg, sufentanil 1.5 μg/kg, and granisetron 100 μg/kg in 100 ml of normal saline in group Dex-Suf. The PCA pump was set up with a 0.5 ml bolus dose, a 15 rain lockout interval and background infusion at a rate of 2 ml/h after a loading dose of sufentanil 0.1 μg/kg. When Faces Pain Scale score〉2, sufentanil 0.1 μg/kg was injected intravenously as rescue analgesic. The consumption of sufentanil was recorded within 48 h after operation. Ramsay sedation scores at static and dynamic （during dressing changes） conditions were assessed after operation. The parents＇ satisfaction, requirement for rescue analgesics and incidence of adverse reactions such as agitation, nausea and vomiting were recorded after operation. Results Compared with group Suf, Ramsay sedation scores at static and dynamic conditions and patients＇ satisfaction scores were significantly increased, and the consumption of sufentanil, requirement for rescue analgesics and incidence of agitation, nausea and vomiting were significantly decreased after operation in group Dex-Suf （P〈0.05）. Conclusion Dexmedetomidine significa

关 键 词：右美托咪啶 舒芬太尼 烧伤 皮肤移植 镇痛 病人控制 儿童 

分 类 号：R726.1[医药卫生—儿科]