右美托咪定可改善大面积烧伤患者术后芬太尼静脉镇痛效果

Improvement of dexmedetomidine to postoperative intravenous analgesia by fentanyl in patients with large-area burn

目的 观察右美托咪定（dexmedetomidine,Dex）用于大面积烧伤患者术后镇痛的有效性和安全性. 方法 择期全身麻醉下首次行四肢切痂术烧伤患者40例,采用随机数字表法分为2组（每组20例）：Ⅰ组采用芬太尼静脉自控镇痛（patient-controlled intravenous analgesia,PCIA）,Ⅱ组采用芬太尼＋Dex PCIA.分别在术后4、8、24、48 h时记录视觉模拟评分（visual analogue scales,VAS）、Ramsay评分,并记录恶心呕吐、嗜睡、心动过缓、呼吸抑制等副作用发生率,在术后48 h记录患者对镇痛效果的满意度. 结果 Ⅱ组各时点VAS评分都明显低于Ⅰ组,Ⅱ组恶心、呕吐的发生率（5％）明显低于Ⅰ组（35％,P＜0.05）.两组各时间点Ramsay评分差异无统计学意义.Ⅱ组患者镇痛满意度（95％）明显高于Ⅰ组（65％,P＜0.05）. 结论 Dex可显著改善大面积烧伤患者术后芬太尼的镇痛效果,并减少副作用发生.

Objective To evaluate the efficacy and safety of dexmedetomidine （Dex） used for postoperative intravenous analgesia in patients with large-area burn.Methods Forty 18-60 years old patients,undergoing escharectomy were randomly assigned into two groups with 20 cases each.Group Ⅰ received patient-controlled intravenous analgesia（PCIA） with fenmnyl,Group Ⅱ received PCIA with Dex and fentanyl.Visual analogue scales （VAS） scores and Ramsay scores at 4,8,24 h and 48 h after operation and the incidence of nausea and vomit,somnolence,bradycardia and respiratory depression were recorded.The satisfactory degree of patients was recorded at 48 h.Results Compared with Group Ⅰ,the VAS score of Group Ⅱ at any time point and the incidence of nausea and vomit in Group Ⅱ were significantly decreased.There was no significant difference in the incidence of somnolence,bradycardia,respiratory depression and Ramsay score between the two groups.The satisfactory degree of patients in Group Ⅱ （95％） was obviously higher than that in Group Ⅰ （65％,P＜0.05） at 48 h.Conclusions The application of Dex coupled with fentanyl in PCIA can result in satisfactory effect of analgesia and sedation and decrease the incidence of nausea and vomit significantly,which will do more good to the patients with large-area burn.