亚麻醉剂量氯胺酮联合芬太尼对大面积烧伤床旁换药老年病人疼痛评分及焦虑的影响

Effect of subanesthetic dose of ketamine combined with fentanyl on pain score and anxiety in the elderly patients with large area burn requiring bedside dressing change

目的研究亚麻醉剂量氯胺酮联合芬太尼对大面积烧伤床旁换药老年病人疼痛评分及焦虑的影响。方法选取我院烧伤外科2016年1月至2018年1月深Ⅱ度、Ⅲ度烧伤老年病人138例,分为4组,A组(34例):凯纷+氯胺酮+盐酸右美托咪定; B组(34例):凯纷+芬太尼+盐酸右美托咪定; C组(35例):凯纷+芬太尼+氯胺酮+盐酸右美托咪定; D组(35例):凯纷(不愿接受无痛换药的病人)。观察并比较4组换药前后不同时刻视觉模拟评分(VAS)及心率(HR)、平均动脉血压(MAP)、血氧饱和度(Sp O2)水平变化。同时,观察病人换药后48 h内恶心呕吐、瘙痒、头晕的发生情况及焦虑状态。结果 A、B、D组换药完毕时、换药后2 h及换药后4 h VAS评分与换药前相比均升高(P<0. 05); C组换药前、后VAS评分比较,差异无统计学意义(P<0. 05); C组换药后各个时间点VAS评分均低于A、B、D组,差异均具有统计学意义(P<0. 05)。4组换药后不同时刻HR、MAP、Sp O2及换药后48 h内不良反应的发生率比较差异均无统计学意义(P>0. 05)。换药后24 h,4组医院焦虑抑郁量表(HADS)评分均明显下降(P<0. 05),C组下降最明显,4组间比较,差异有统计学意义(P<0. 05)。结论大面积烧伤床旁换药老年病人使用亚麻醉剂量氯胺酮联合芬太尼的镇痛效果较好,对生命体征影响小,可明显改善焦虑,值得临床进一步研究。

Objective To explore the effect of subanesthetic dose of ketamine combined with fentanyl on pain score and anxiety in the elderly patients with large-area burns.Methods A total of 138 elderly patients with deep second-degree or third-degree burns in our hospital from January 2016 to January 2018 were enrolled. Patients were divided into four groups, group A(Kay+ketamine+dexmetidine hydrochloride, n = 34),group B(Kay+fentanyl+dexmetidine hydrochloride, n = 34),group C(Kay+fentanyl+ketamine+dexmetidine hydrochloride, n = 35) and group D(Kay only, n = 35). The changes of visual analogy score (VAS) and heart rate (HR), mean arterial blood pressure (MAP), and blood oxygen saturation (SpO 2) at different time points were compared before and after dressing change. At the same time, the occurrence of nausea and vomiting, itching, dizziness and anxiety state within 48 hours after bedside dressing change were observed.Results At the end of dressing change, 2 hours and 4 hours after dressing change, the score of VAS in group A, group B and group D was significantly increased than that before dressing change( P < 0.05). The score of VAS in group C was lower than that in group A, group B and group D at each time point after dressing change( P < 0.05). There were no significant differences in vital sign and the incidence rate of adverse reactions within 48 hours after the dressing change among the four groups( P > 0.05). The score of Hospital Anxiety and Depression Scale(HADS)24 hours after the dressing change was decreased significantly than that before the dressing change in four groups,especially in group C, and there were significant differences among the four groups( P < 0.05).Conclusions The subanesthetic dose of ketamine combined with fentanyl has favorable analgesic effect and less impact on vital signs for the elderly patients with large area burn requiring bedside dressing change,and it can relieve the anxiety, which is worthy of further clinical research.