观察小剂量氯胺酮复合地佐辛对烧伤切痂植皮术后自控静脉镇痛效应的影响  

Observation on effect of low dose ketamine combined with dezocine on patient-controlled intravenous analgesia after escharectomy and skin grafting

作　　者：冯甜甜 高春霖[1] FENG Tian-tian;GAO Chun-lin(Department of Anesthesiology, Second Hospital Affiliated to Tianjin Medical University/Affiliated Hospital of Nankai University （Tianjin Fourth Hospital）, Tianjin 300211, China)

机构地区：[1]天津医科大学第二医院麻醉科,300211 [2]南开大学附属医院(天津市第四医院)麻醉科

出　　处：《中国实用医药》2017年第34期95-97,共3页China Practical Medicine

基　　金：2017年天津医学会麻醉学分会中青年科研基金培育基金项基金资助(项目编号:TJMZJJ-2017-01)

摘　　要：目的观察小剂量氯胺酮复合地佐辛对烧伤切痂植皮术后静脉自控镇痛(PCIA)效应的影响。方法 80例择期烧伤切痂植皮术患者,根据术后PCIA药物配比方法分为D1、D2、D3和D4组,每组20例。D1组给予地佐辛1.2 mg/kg,D2、D3、D4组分别采用地佐辛1.0、0.8、0.6 mg/kg复合氯胺酮3 mg/kg。记录四组镇痛泵开始后1、2、4、8、16及24 h患者的视觉模拟评分法(VAS)评分及使用PCIA泵期间的不良反应情况。动态监测各时点平均动脉压(MAP)、心率(HR)、呼吸(R)、脉搏氧饱和度(Sp O2)的变化。比较四组切痂面积、手术时间、输液总量、苏醒时间和拔管时间。结果四组切痂面积、手术时间、输液总量、苏醒时间和拔管时间比较差异均无统计学意义(P>0.05)。D2组各时间点VAS评分较D1、D3、D4组低,差异有统计学意义(P<0.05);D1、D3和D4组各时间点VAS评分比较差异无统计学意义(P>0.05)。D2组出现恶心呕吐患者9例,不良反应发生率为45%;D1组出现恶心呕吐患者2例,不良反应发生率为10%;D3组出现恶心呕吐患者2例,不良反应发生率为10%;D4组出现恶心呕吐患者1例,不良反应发生率为5%;D1、D3组、D4组不良反应发生率均低于D2组,差异具有统计学意义(P<0.05);D1、D2、D3组不良反应发生率组间比较差异无统计学意义(P>0.05)。各组均未出现瘙痒、幻觉、嗜睡、低血压或高血压等不良反应。结论小剂量氯胺酮复合地佐辛应用于烧伤切痂植皮术后PCIA,呼吸循环稳定,镇痛、镇静效果满意,而且可减少不良反应,效果安全可靠。Objective To observe the effect of low dose ketamine combined with dezocine on patientcontrolled intravenous analgesia（PCIA） after escharectomy and skin grafting. Methods A total of 80 patients with selective escharectomy and skin grafting were divided by postoperative PCIA drug matching method into D1, D2, D3 and D4 group, with 20 cases in each group. D1 group received 1.2 mg/kg of dezocine, and D2, D3, D4 group received 1.0, 0.8, 0.6 mg/kg of dezocine combined with 3 mg/kg of ketamine respectively. The visual analogue scale（VAS） scores in 1, 2, 4, 8, 16 and 24 h after the start of the analgesia pump and the adverse reactions during PCIA pump of the four groups were recorded. The changes of mean arterial pressure（MAP）, heart rate（HR）, respiration（R） and pulse oxygen saturation（Sp O2） were monitored dynamically. Comparison were made on scab area, operation time, infusion volume, recovery time and extubation time of four groups. Results D2 group had lower VAS score at 8, 16 and 24 h than D1, D3 and D4 group, and their difference was statistically significant（P〈0.05）. D1, D3, D4 group had lower incidence of adverse reactions than D2 group, and their difference was statistically significant（P〈0.05）. D1, D2, D3 group had no statistically significant difference in incidence of adverse reactions（P〉0.05）. There was no itching, hallucinations, lethargy, hypotension, or hypertension in each group. Conclusion Application of low-dose ketamine and dezocine on PCIA after burn escharectomy and skin grafting provides stable respiratory and circulatory and satisfactory analgesia and sedation effect. It was safe and reliable to reduce the effect of high dose of dezocine alone.

关 键 词：静脉自控镇痛 烧伤 切痂植皮术 氯胺酮 地佐辛 

分 类 号：R614[医药卫生—麻醉学]