舒芬太尼自控镇痛联合丙泊酚镇静在烧伤换药中的应用

摘要/Abstract

摘要： 目的: 研究舒芬太尼自控镇痛(PCA)联合丙泊酚镇静在烧伤换药中的应用。方法: 选取ASAⅠ或Ⅱ级,烧伤面积20%～50%的Ⅱ～Ⅲ度烧伤患者60例,随机分为3组:1 μg 组、3 μg 组和 5 μg 组,每组20例。换药前 5 min 静脉注射舒芬太尼 0.25 μg/kg,3 min 后丙泊酚靶控输注(TCI),最初效应室浓度为 1.5 μg/kg,调整其浓度使BIS值较基础值降低15%～20%后开始换药。PCA:舒芬太尼浓度为 1 μg/mL,维持为 2 mL/h,3组按压锁定给药量分别为 1 mL、3 mL 和 5 mL,锁定时间为 5 min。记录丙泊酚和舒芬太尼用量、每 10 min 平均按压次数、给药次数和计算按压次数/给药次数比值;采用VAS法进行疼痛评分,评定手术医生和患者满意度及不良事件情况。结果: 5 μg 组丙泊酚用量较 3 μg 组和1 μg 组减少(P<0.01,P<0.05),而 3 μg 组较 1 μg 组减少(P<0.05);舒芬太尼总使用量 5 μg 组和 3 μg 组较 1 μg 组增多(P＜0.01)。换药中平均VAS评分、每 10 min 按压次数、按压次数/给药次数比值 1 μg 组显著高于 3 μg 组和 5 μg 组(P＜0.01)。5 μg 组和 3 μg 组患者和医生满意度较 1 μg 组高(P＜0.01),5 μg 组和 3 μg 组比较无统计学差异(P>0.05);5 μg 组眩晕发生率显著高于 1 μg 和 3 μg 组(P<0.01,P<0.05)。结论: 舒芬太尼 0.25 μg/kg 负荷量后PCA,持续 2 mL/h,按压泵量 3 mL(3 μg),锁定时间 5 min,联合丙泊酚镇静用于烧伤病人换药是安全、可行的。

关键词: 舒芬太尼, 自控镇痛, 镇静, 烧伤换药

Abstract: AIM: To investigate the feasibility of patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes. METHODS: Sixty patients ASA Ⅰ-Ⅱ who had thermal burns of 20-50 percent total body surface area and were scheduled for burn dressing changes were randomly divided into three groups with twenty patients in each group. Each patient received an initial loading dose of i.v. sulfentanyl 0.25 μg/kg 5 min before the procedure, received target controlled infusion with propofol initial effect-site concentrations from 0.15 μg/kg at 2 min before the procedure. Adjusting the propofol effect-site concentrations to maintain BIS decline by 15-20 percent of baseline. The patients were allocated to receive on-demand analgesia with one of the three PCA-sulfentanyl demand doses-1, 3, and 5ug. The demand dose was delivered i.v. at a constant rate by a PCA pump with a 5-min lockout interval. Propofol and sulfentanyl comsumption, demands made per 10min,delivered per 10min and demand/delivery ratio were reorded, Pain intensity was assessed by the VAS score, Doctor and patents' satisfactories were asked. Incidence of postoperative nausea and vomiting, dizzy, respiratory depression and hypotension were recorded. RESULTS: Propofol comsumption in 5 μg group were significantly lower than those in 1 and 3 μg group(P<0.01, P<0.05), but higher in 1 μg group than those in 3 μg group(P<0.05). Total sulfentanyl comsumption dosage in 5 μg and 3μg group were significantly higher than those in the 1 μg group(P＜0.01). During the dressing change procedure, mean VAS scores, demands made per 10min, delivered per 10min and demand/delivery ratio in the sulfentanyl 1 μg groups were significantly higher than those in the 3 and 5 μg groups(P<0.01), and there are no difference between 3 μg group and 5 μg group(P>0.05). Patients and doctors' satisfactories were signicantly higher in 3 and 5 μg groups than those in 1 μg group(P＜0.01), while no difference between 3 μg group and 5 μg group(P>0.05). The incidence of dizzy were signicantly higher in 5 μg groups than those in 1 μg and 3 μg group(P<0.01, P<0.05). CONCLUSION: The optimal PCA-sulfentanyl demand dose in our study is 3 μg after an i.v. initial loading dose of 0.25 μg/kg and a lockout interval of 5 minutes, Combining with propofol for sedation is safety and feasible.

Key words: Sulfentanyl, Patient-controlled analgesia, Sedation, Burn dressing change

中图分类号:

R614

王明仓, 陈玲阳, 林仙菊, 曹东航, 项海飞. 舒芬太尼自控镇痛联合丙泊酚镇静在烧伤换药中的应用[J]. 中国临床药理学与治疗学, 2010, 15(4): 449-453.

WANG Ming-cang, CHEN Ling-yang, LIN Xian-ju, CAO Dong-hang, XIANG Hai-fei. Patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(4): 449-453.

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