不同镇痛镇静模式在严重烧伤患者回收期应用效果分析  

Effect of different analgesia sedation modes in the recovery period of severe burn patients

作　　者：代涛 李延仓[2] 娄季鹤[2] 夏成德[2] 王磊[2] 张建[2] 赵孝开 吕涛[2] 李晓亮[2] 裴会乐 郭继龙 刘冰[2] DAI Tao;LI Yancang;LOU Jihe;XIA Chengde;WANG Lei;ZHANG Jian;ZHAO Xiaokai;LYU Tao;LI Xiaoliang;PEI Huile;CUO Jilong;LIU Bing(Department of Burns Surgery,the Third Affiliated Hospital of Henan Uniwersity of Science and Technology,Luoyang 471003,Henan Province,China;Department of Burns Surgery,the First People's Hospital of Zhengzhou,Zhengzhou 450004,Henan Province,China)

机构地区：[1]河南科技大学第三附属医院烧伤科,河南洛阳471000 [2]郑州市第一人民医院烧伤科,河南郑州450004

出　　处：《新乡医学院学报》2020年第1期44-47,共4页Journal of Xinxiang Medical University

基　　金：河南省科技攻关项目(编号:201303215).

摘　　要：目的比较右美托咪定与咪达唑仑分别联合舒芬太尼在严重烧伤患者回收期的镇痛镇静效果。方法选择2016年1月至2018年12月河南科技大学第三附属医院收治的严重烧伤患者84例为研究对象。将患者分为右美托咪定组和咪达唑仑组,每组42例。2组患者均给予舒芬太尼进行镇痛,进入回收期后右美托咪定组患者给予右美托咪定进行镇静,咪达唑仑组患者给予咪达唑仑进行镇静。比较2组患者进入回收期后第1、3、5、7、9天重症监护室疼痛观察工具(CPOT)评分和镇静-躁动评分(SAS);比较2组患者在烧伤重症监护室(BICU)住院时间以及谵妄和不良反应发生率。结果2组患者在回收期后各时间点的镇痛评分比较差异均无统计学意义(P>0.05)。2组患者进入回收期后第1天SAS评分比较差异无统计学意义(P>0.05),其余各时间点咪达唑仑组患者SAS评分均显著高于右美托咪定组(P<0.05)。右美托咪定组和咪达唑仑患者在BICU住院时间分别为(15.81±5.02)、(20.95±4.94)d,右美托咪定组患者在BICU住院时间显著短于咪达唑仑组(t=-4.730,P<0.05)。右美托咪定组和咪达唑仑组患者谵妄发生率分别为9.52%(4/42)、30.95%(13/42),不良反应发生率分别为35.71%(15/42)、59.52%(25/42);右美托咪定组患者谵妄及不良反应发生率均显著低于咪达唑仑组(χ^2=5.972、4.773,P<0.05)。结论右美托咪定与咪达唑仑分别联合舒芬太尼对严重烧伤患者均有较好的镇痛镇静效果,对于回收期患者,右美托咪定的镇静效果优于咪达唑仑,且患者谵妄及不良反应发生率低。Objective To compare the effect of analgesia and sedation of dexmedetomidine and midazolam combined with sufentanil in severe burn patients during the recovery period.Methods Eighty-four severe burn patients admitted to the Third Affiliated Hospital of Henan University of Science and Technology from January 2016 to December 2018 were selected as the study objects and were divided into dexmedetomidine group(n=42)and midazolam group(n=42).All patients were given sufentanil for analgesia;based on this,the patients in dexmedetomidine group were given dexmedetomidine for sedation,the patients in midazolam group were given midazolam for sedation.The ritical care pain observation tool(CPOT)score,and sedation-agitation scale(SAS)were compared between the two groups on the 1 st,3 rd,5 th,7 thand 9 thday after the recovery period;and the length of stay in burn intensive care unit(BICU),the incidence of delirium and adverse reactions were compared between the two groups.Results There was no significant difference in the CPOT scores of patients between the two groups(P>0.05).There was no significant difference in SAS scores of patients between the two groups on the first day after the recovery period(P>0.05);the SAS score of patients in midazolam group was significantly higher than that in the dexmedetomidine group at the other time point after the recovery period(P>0.05).The length of stay in BICU of patients in dexmedetomidine group and midazolam group was(15.81±5.02)and(20.95±4.94)days,respectively;the length of stay in BICU of patients in dexmedetomidine group was significantly shorter than that in midazolam group(t=-4.730,P<0.05).The incidence of delirium of patients in dexmedetomidine group and midazolam group was 9.52%(4/42)and 30.95%(13/42),respectively;the incidence of adverse reactions of patients in dexmedetomidine group and midazolam group was 35.71%(15/42)and 59.52%(25/42),respectively;the incidences of delirium and adverse reactions of patients in dexmedetomidine group were significantly lower than those in t

关 键 词：严重烧伤 回收期 舒芬太尼 镇痛 烧伤重症监护室 

分 类 号：R453[医药卫生—治疗学] R644[医药卫生—临床医学]