稀释氧化亚氮吸入在烧伤患者创面换药中及换药后的镇痛镇静研究

Analgesic and sedative effects of inhaling a mixture of nitrous oxide and oxygen on burn patient dur- ing and after dressing change

目的探讨稀释氧化亚氮吸入在烧伤患者创面换药中及换药后的镇痛、镇静作用。方法选取2011年10月-2012年9月第二军医大学长海医院全军烧伤研究所、郑州市第一人民医院烧伤科和宁夏医科大学总医院烧伤整形科收治的240例烧伤患者进入本研究。采用计算机随机法将患者分为对照组（创面换药中吸入氧气）60例、治疗组（创面换药中吸人体积分数为65％的氧化亚氮）180例，2组患者其余治疗相同。于换药前、换药中、换药后记录患者的心率、收缩压、舒张压、SO2，记录患者的视觉模拟评分（VAS），采用汉化版烧伤专用疼痛-焦虑量表（C—BSPAS）进行镇静评分，观察患者有无不良反应，．对数据进行协方差分析、x^2检验、方差分析及秩和检验。结果换药前2组患者心率、收缩压、舒张胝和SO，组间比较差异均无统计学意义（f值分别为0．76、0．06、1．11和0．70，P值均大于0．05）。与对照组比较，治疗组患者换药中心率、收缩压、舒张压和SO，明显改善（F值分别为81．78、146．36、226．44、205．62，P值均小于0。01）。2组患者换药后舒张压值接近（F=0．31，P〉0．05），心牢、收缩压和SO，组间比较差异均有统计学意义（，值分别为7．02、8．69、12．23，P〈0．05或P〈0．01）。换药前2组患者的VAS评分接近（Z=0．2l，P〉0．05）。与对照组[（9．4±0．7）、（I．7±2．5）分]比较，治疗组患者换药中以及换药后的VAS评分[（1．6±1．3）、（0．7±1．1）分]均明娃降低（Z值分别为I1．84、3．35，P值均小于0．01）。换药前2组患者的C—BSPAS评分接近（Z=0．62，P〉0．05）；0对照组[（75±13）、（73±12）分]比较，治疗组患者换药中及换药后C—BSI，As评分[（9±15）、（9±14）分]明显降低（z值分别为11．9l、12．28，P值均小于0．01）。2组患者在换药前、换药中、换药后均未发生明显不良反应。结论稀释氧化弧氮吸入在烧伤创面换药中具有明显的镇痛、镇静作用，可应用于日常烧（创）伤创面换药处理。

Objective To investigate the analgesic and sedative effects of inhaling a mixture of ni- trous oxide and oxygen on burn patient during and after dressing change. Methods A total of 240 burn patients hospitalized ill tire Institute of Burn Research of Changhai Hospital Affiliated to the Second Military Medical University, Department of Burns of the First People＇s Hospital in Zhengzhou, and Department of Burns and Plastic Surgm＇y of General Hospital of Ningxia Medical University from October 2011 to September 2012 wcre enrolled in our study, and they were all in accordance with the inclusion criteria. The 240 pa- tients were divided into control group （ n = 60, treated with inhalation of oxygen during dressing change） and treatment group （ n = 180, treated with inhalation of a mixture of 65% nitrous oxide and oxygen during dressing change） according to the computer-generated list of random number. The other treatments in control group and treatment group were the same. Before, during, and after dressing change, heart rate （HR） , sys- tolic blood pressure （SBP）, diastolic blood pressure （DBP）, oxygen saturation （SO2 ）, and adverse effects were observed. The degree of pain and anxiety felt by the patients were respectively evaluated with the visual analogue scale （VAS） and Chinese version of the burn specific pain anxiety scale （C-BSPAS） at the same time points as above. Data were processed with analysis of covariance, chi-square test, analysis of variance, and rank sum test. Results There were no significant differences between control group and treatment group in the levels of HR, SBP, DBP, and SO2 before dressing change （with F values respectively 0.76, 0. 06, 1.11, 0.70, P values all above 0.05 ）. Compared with those of control group, the levels of HR, SBP, DBP, and SO2 in treatment group were significantly ameliorated during dressing change （with F values respectively 81.78, 146.36, 226.44, 205.62, P values all below 0.01 ）. After dressing change, the levels of DBP in the two groups were close （ F =0.31, P 〉0.05） , but the levels of HR, SBP, and SO2 showed statistical differences （ with F values respectively 7.02, 8.69, 12.23, P 〈 0.05 or P 〈 0.01 ）. Before dressing change, the VAS scores were approximate between control group and treatment group （ Z = 0.21, P 〉 0.05）. Compared with those in control group （9.4 ＋ 0.7, 1.7 ＋ 2.5 ）, the VAS scores were signifi- cantly lowered in treatment group during and after dressing change （ 1.6 ＋ 1.3, 0.7 -＋ 1.1, with Z values re- spectively 11.84, 3.35, P values all below 0. 01 ）. There was no significant difference in C-BSPAS score between control group and treatment group before dressing change （ Z = 0.62, P 〉 0.05）. Compared with those in control group （75 ＋ 13, 73 ＋ 12） , the C-BSPAS scores in treatment group were decreased during and after dressing change （9 ＋ 15, 9 ＋ 14, with Z values respectively 11.91, 12.28, P values all below 0.01 ）. There were no obvious adverse effects in two groups before, during, and after dressing change. Conclusions A mixture of nitrous oxide and oxygen seems to have obvious analgesic and sedative effects on burn patients during dressing change, and it can be widely used.