摘要
目的探讨右美托咪定联合小剂量氯胺酮在重度烧伤患者植皮术中瑞芬太尼麻醉后痛觉过敏中的应用效果。方法2019年3月至2020年3月在我院接受植皮手术治疗的98例重度烧伤患者,根据麻醉用药不同分为研究组(右美托咪定联合小剂量氯胺酮)及对照组(右美托咪定)各49例。比较两组手术相关指标、术后2、4、8、12及24h的视觉模拟量表(VAS)评分,记录麻醉诱导前(T0)、麻醉诱导后(T1)、插管后(T2)、手术中(T3)、拔除气管导管时(T4)以及拔除气管导管后10 min(T5)的心率(HR)及平均动脉压(MAP),于拔管后30 min评估Ramsay镇静分级,比较两组不良反应情况。结果两组植皮面积、术中失血量、手术时间、苏醒时间以及拔除气管导管时间比较无统计学意义(P>0.05);术后两组的疼痛评分均下降,且研究组术后不同时点的VAS评分均低于对照组(P<0.05);研究组拔管后30 min镇静良好率为87.86%高于对照组的71.43%(P<0.05);诱导后,两组HR和MAP水平均呈先升后降(P<0.05),除T1时点MAP外,T1~T5时点研究组HR、MAP水平均低于对照组(P<0.05)。对照组疼痛过敏发生情况明显高于研究组(P<0.05),两组其他不良反应发生情况比较无明显差异(P>0.05)。结论右美托咪定联合小剂量氯胺酮在重度烧伤患者植皮术中瑞芬太尼麻醉后痛觉过敏中预防效果较佳,且能有效减轻患者术后疼痛程度,维持血流动力学的稳定,改善患者术后痛觉过敏现象,有一定推广价值。
Objective To explore the application effect of dexmedetomidine combined with low-dose ketamine in preventing hyperalgesia after remifentanil anesthesia during dermatoplasty of patients with severe burns.Methods Clinical data of 98 patients with severe burns who underwent dermatoplasty in our hospital from March 2019 to March 2020 were retrospectively collected.According to anesthesia medication,they were divided into a study group treated with dexmedetomidine combined with low-dose ketamine(n=49)and a control group treated with dexmedetomidine(n=49).Surgery related indicators,visual analogue scale(VAS)scores after 2h,4h,8h,12h and 24h of surgery,heart rate(HR)and mean arterial pressure(MAP)before induction of anesthesia(T0),after induction of anesthesia(T1),after intubation(T2),during operation(T3),at time of tracheal tube removal(T4),and after 10 minutes of tracheal tube removal(T5)were compared between the two groups.The sedation status was evaluated by using Ramsay sedation classification after 30 minutes of extubation.The adverse reactions were also compared between the two groups.Results There was no significant difference in skin graft area,intraoperative blood loss,operation time,wake-up time,and removal time of tracheal tube between the two groups(P>0.05).After treatment,the pain scores of the two groups were decreased gradually,and the VAS scores at different time after treatment of the study group were lower than those of the control group(P<0.05).The rate of good sedation in the study group was 87.86%,which was higher than 71.43%in the control group after 30 minutes of extubation(P<0.05).After induction,the HR and MAP levels of the two groups were increased first and then decreased(P<0.05).Except for the MAP at T1,the HR and MAP levels in the study group were lower than those in the control group from T1 to T5(P<0.05).The incidence of pain and allergy in the control group which was significantly higher than in the study group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine combined with low-dose ketamine is effective in preventing hyperalgesia after remifentanil anesthesia during dermatoplasty of patients with severe burns.It can effectively reduce the postoperative pain of patients and maintain hemodynamic stability,and improve the postoperative hyperalgesia.It has certain promotion value.
作者
原晓晖
蒋筱扬
汪刚
苗文静
孙平
YUAN Xiao-hui;JIANG Xiao-yang;WANG Gang;MIAO Wen-jing;SUN Ping(Shouyi District of Wuhan Third Hospital, Wuhan 430000, China)
出处
《实用医院临床杂志》
2022年第1期51-55,共5页
Practical Journal of Clinical Medicine
基金
湖北省科技计划项目(编号:2019CF864)。
