亚麻醉剂量艾司氯胺酮复合右美托咪定预防烧伤切痂植皮手术瑞芬太尼致痛觉过敏的效果  

The effect of subanesthetic dose of esmketamine combined with dexmedetomidine in preventing pain sensitivity caused by remifentanil in burn escharectomy and skin grafting

作　　者：陈熹 曾宇 张金辉 CHEN Xi;ZENG Yu;ZHANG Jin-hui(Nankai University Affiliated Hospital(Tianjin Fourth Hospital),Tianjin 300000,China)

机构地区：[1]南开大学附属医院(天津市第四医院)麻醉科,天津300000

出　　处：《中国处方药》2023年第5期110-112,共3页Journal of China Prescription Drug

摘　　要：目的 探讨亚麻醉剂量艾司氯胺酮联合右美托咪定预防烧伤植皮患者瑞芬太尼致痛觉敏感的临床效果。方法 选取南开大学附属医院(天津市第四医院)2021年2月~2022年8月择期全麻行切削痂植皮患者159例,随机分为艾司氯胺酮+右美托咪定组(DE组)、艾司氯胺酮组(E组)、右美托咪定组(D组)和对照组(C组);DE组于切削痂前予0.25 mg/kg艾司氯胺酮,于诱导前10 min内微量泵入0.5μg/kg右美托咪定,0.5μg/(kg·h)维持至植皮结束;E组于切削痂前予0.25 mg/kg艾司氯胺酮;D组于诱导前泵入0.5μg/kg右美托咪定,0.5μg/(kg·h)维持至植皮结束;C组在诱导前以及切削痂前均给予生理盐水5 ml。PCIA镇痛方案:1.5μg/ml舒芬太尼,容量100 ml,背景输注速率2 ml/h。维持VAS疼痛评分<4分。记录患者苏醒时间、拔管时间以及术后24 h内舒芬太尼用量,以及恶心呕吐、心动过缓、呼吸抑制等发生情况。结果 与C组相比,D、E、DE组术后1~6 h、6~12 h以及12~24 h各时段舒芬太尼用量均降低,恶心呕吐发生率均降低,DE组心动过缓发生率明显低于其余三组,差异有统计学意义(P<0.05)。结论 亚麻醉剂量艾司氯胺酮联合右美托咪可明显缓解烧伤切削痂植皮术瑞芬太尼所致痛觉敏感,患者苏醒时间和拔管时间并未延长,心动过缓、呼吸抑制等相关不良反应发生率低。Objective To observe the clinical effect of subanesthetic esketamine and dexmedetomidine against remifentanil pain sensitivity in burn skin graft patients.Methods Selected 159 patients in Nankai University Affiliated Hospital(Tianjin Fourth Hospital)from February 2021 to August 2022 randomly divided into 4 groups:esketamine and dexmedetomidine(Group DE),esketamine(Group E),dexmedetomidine(Group D)and control group(Group C);In DE group,0.25 mg/kg esketamine was injected before scab,micropumped 0.5μg/kg dexmedetomidine within 10 min before induction,0.5μg/(kg·h)maintenance infusion until the end of skin graft;Group E injected 0.25 mg/kg esketamine before scab;Group D pumped 0.5μg/kg dexmedetomidine before induction,0.5μg/(kg·h)maintenance infusion until the end of skin graft;In group C,5 ml of normal saline was given before induction and before scab cutting;PCIA analgesic plan:1.5μg/ml sufentanil,volume 100 ml,background infusion rate 2 ml/h.Maintain a VAS pain score of less than 4 points.The recovery time,extubation time,sufentanil dosage within 24 hours after operation,the occurrence of nausea,vomiting,bradycardia,and respiratory depression were recorded.Results Compared with group C,dosage of sufentanil in group D,E and DE were decreased at 1~6 h、6~12 h and 12~24 h,and the incidence of nausea and vomiting were decreased.The incidence of bradycardia was significantly lower than other 3 groups(P<0.05).Conclusion Subanesthetic dose of esketamine combined with dexmedetomi can obviously relieve the pain sensitivity caused by remifentanil in burn cutting and scab skin grafting,and the recovery time and extubation time are not prolonged,and the incidence of related adverse reactions such as bradycardia and respiratory depression is low.

关 键 词：右美托咪定 艾司氯胺酮 切痂植皮手术 痛觉过敏 镇静镇痛 

分 类 号：R614[医药卫生—麻醉学]