舒芬太尼自控镇痛联合丙泊酚镇静在烧伤换药中的应用

Patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes

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:1μg组、3μg组和5μg组,每组20例。换药前5 min静脉注射舒芬太尼0.25μg/kg,3 min后丙泊酚靶控输注(TCI),最初效应室浓度为1.5μg/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1μg/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:5μg组丙泊酚用量较3μg组和1μg组减少(P<0.01,P<0.05),而3μg组较1μg组减少(P<0.05);舒芬太尼总使用量5μg组和3μg组较1μg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1μg组显著高于3μg组和5μg组(P<0.01)。5μg组和3μg组患者和医生满意度较1μg组高(P<0.01),5μg组和3μg组比较无统计学差异(P>0.05);5μg组眩晕发生率显著高于1μg和3μg组(P<0.01,P<0.05)。结论:舒芬太尼0.25μg/kg负荷量后PCA,持续2 mL/h,按压泵量3 mL(3μg),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。

AIM：To investigate the feasibility of patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes. METHODS：Sixty patients ASAⅠ-Ⅱwho 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 0.25μg/kg 5 min before the procedure,received target controlled infusion with propofol initial effect-site concentrations from 0.15μg/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 5μg group were significantly lower than those in 1 and 3μg group（P〈0.01,P〈0.05）,but higher in 1μg group than those in 3μg group（P〈0.05）.Total sulfentanyl comsumption dosage in 5μg and 3μg group were significantly higher than those in the 1μg 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 1μg groups were significantly higher than those in the 3 and 5μg groups（P〈0.01）,and there are no difference between 3μg group and 5μg group （P〉0.05）.Patients and doctors＇ satisfactories were signicantly higher in 3 and 5μg groups than those in 1μg group（P〈0.01）,while no difference between 3μg group and 5μg group（P〉0.05）.The incidence of dizzy were signicantly higher in 5μg groups than those in 1μg and 3μg group（P〈0.01,P〈0.05）.CONCLUSION： The optimal PCA-sulfentanyl demand dose in our study is 3μg after an i.v.initial loading dose of 0.25μg/kg and a lockout interval of 5 minutes,Combining with propofol for sedation is safety and feasible.