摘要
目的评价右美托咪啶复合小剂量芬太尼在烧伤换药麻醉中应用的效果。方法选择30%~80%面积烧伤换药患者30例,均有无麻醉(W组)下换药经历。每例患者均进行两次麻醉,首次麻醉下换药采用单纯泵注右美托咪啶(D组),第2次麻醉下换药采用右美托咪啶复合小剂量芬太尼(DF组)。D组以1μg/kg的负荷量开始泵注右美托咪啶,匀速输注12min。当Ramsay镇静分级3分时以0.5μg/(kg·h)的剂量维持麻醉。DF组在患者Ramsay镇静分级3分时,静脉注射芬太尼1μg/kg。术中以泵注DEX维持镇静。麻醉全过程注意血压、心率、呼吸频率和脉搏血氧饱和度的变化情况。并记录手术过程中呼吸抑制、心动过缓的发生情况。术中及术后所做评估包括:Ramsay镇静评分、VAS疼痛评分、术中医生满意度、术后患者满意度调查。结果所有麻醉患者换药过程中Ramsay评分始终保持在3分,都能顺利进行换药操作。未有呼吸抑制发生,仅有1例心动过缓发生,且为同一位患者。VAS疼痛评分、医生满意度及术后患者满意度情况,右美托咪啶复合小剂量舒芬太尼优于单纯泵注右美托咪啶,单纯泵注右美托咪啶优于不麻醉组。结论 DEX与小剂量芬太尼联合应用,可以安全有效的应用于烧伤换药麻醉中,为烧伤换药提供一种安全有效的无痛方法。
Objective To evaluate the application effect of dexmedetomidine combined with small doses of fentanyl in the anesthesia for burn dressing. Methods Thirty patients with 30%-80% of area burnt and without anesthetic dressing change experience were selected.Every patient received anesthesia twice,of which the first anesthesia received simple pump injection of dexmedetomidine(group D)and the second anesthesia received dexmedetomidine combined with small doses of fentanyl(group DF).With the load capacity of 1 IX g/kg,group D was given the pump infusion of dexmedetomidine at a constant speed for 12 minutes.When the Ramsay sedation score reached 3 points,the anesthesia was maintained at a speed of 0.5 tx g/(kg· h).For the patients in group DF,when the Ramsay sedation score reached 3 points,1 μ g/kg of fentanyl was injected intravenously. Intraoperative sedation was maintained by pump-injecting DEX.The changes of blood pressure,heart rate, respiratory rate and pulse oxygen saturation during the whole process of anesthesia were observed.And the occurrence of respiratory depression and bradycardia was recorded.Intraoperative and postoperative evaluation included Ramsay sedation score,VAS pain score,intraoperative doctor satisfaction and postoperative patient satisfaction survey. Results In the process of anesthetic dressing change,the Ramsay score stayed 3 points all along and the dressing change operation went successfully.No respiratory depression occurred and only one bradycardia appeared.Regarding to the VAS pain score,doctor satisfaction and postoperative patient satisfaction,the dexmedetomidine combined with small doses of fentanyl was superior to the dexmedetomidine and the simple pump injection of dexmedetomidine was superior to the non-anesthesia group. Conclusion DEX combined with small doses of fentanyl can be applied to the anesthesia for burn dressing change safety and effectively, providing a safe,effective and painless method for the burn dressing change.
出处
《中国医药科学》
2013年第5期110-111,共2页
China Medicine And Pharmacy
关键词
右美托咪啶
芬太尼
烧伤换药麻醉
有效性
安全性
Dexmedetomidine
Fentanyl
Anesthesia for burn dressing change
Effectiveness
Safety