瑞芬太尼靶控输注用于烧伤换药的临床研究

Remifentanil target-controlled infusion for dressings change of burn wounds

目的评价瑞芬太尼靶控输注在烧伤换药中的安全性和有效性。方法选择50例择期行烧伤换药的患者,先后观察两次换药,一次为静脉注射地佐辛10 mg,另一次为瑞芬太尼靶控输注维持效应室浓度2.0ng/ml,比较两次的麻醉效果及不良反应情况。结果瑞芬太尼组术中NRS评分低于地佐辛组(2.8±0.7 vs6.5±1.2,P<0.05),患者满意度更高(4.6 vs 2.3,P<0.05)。瑞芬太尼组有2例心动过缓、1例低血压,无恶心呕吐、呼吸抑制;而地佐辛组仅有3例恶心,余未发生。但瑞芬太尼组Ramsay镇静评分较地佐辛组低(2.3±1.2vs 4.4±0.8,P<0.05)。结论瑞芬太尼靶控输注用于烧伤换药,具有镇痛良好、保留患者意识和自主呼吸、副作用小等特点。

【Objective】 To evaluate safety and efficacy of a target-controlled infusion of remifentanil during dressings change of burn wounds.【Methods】Fifty ASA I-III patients, 18～60 years old and scheduled for dressings change of burn wounds were observed twice successively, one time was given dizocine 10 mg intravenously, the other time was received target-controlled infusion（TCI） of remifentanil with the target effect site concentration set at 2.0ng/m L. The anesthesia effect and relative adverse reaction were compared between the two groups. 【Results】Intraoperative numeric rating scales were significantly lower in remifentanil group than that in dizocine group（2.8±0.7 vs.6.5±1.2, P〈0.05）. Quality of anesthesia was rated highly satisfactory in 4.6 of remifentanil group vs. 2.3 of dizocine group. Bradycardia, and hypotension were observed in 2, and 1 patient in remifentanil group, respectively, no patients in dizocine group. There was no patient with respiratory depression in both groups. There was no patients with nausea in remifentanil group vs. 3 patients in dizocine group. Ramsay sedation scores were（2.3±1.2） in remifentanil group and（4.4±0.8） in dizocine group（P〈0.05）.【Conclusion】Remifentanil TCI can be used safely and effectively in dressings change of burn wounds with efficient analgesia, adequate respiration with conscious state, and lower incidence of complications.