摘要
目的探讨不同剂量艾司氯胺酮复合舒芬太尼在烧伤术后患者自控静脉镇痛(PCIA)中的临床应用效果。方法选取2022年1月至2023年1月河北省张家口市第一医院收治的104例烧伤患者为研究对象,在组间基线特征可比的原则上,采用随机数字表法分为A组、B组、C组和D组,每组26例。A组患者术后采用2μg/kg舒芬太尼PCIA,B组患者术后采用0.75 mg/kg艾司氯胺酮+1.5μg/kg舒芬太尼PCIA,C组患者术后采用1.0 mg/kg艾司氯胺酮+1.5μg/kg舒芬太尼PCIA,D组患者术后采用1.5 mg/kg艾司氯胺酮+1.5μg/kg舒芬太尼PCIA。比较分析四组患者术后不同时间点的视觉模拟评分法(VAS)评分、手术前后的应激反应指标[去甲肾上腺素(NE)、皮质醇(COR)、超氧化物歧化酶(SOD)、晚期氧化蛋白产物(AOPPs)]、手术前后的血流动力学指标[收缩压(SBP)、心率(HR)、平均动脉压(MAP)]、术后48 h的镇静效果,以及术后不良反应发生率。结果术后12、24、48 h,B组、C组、D组患者的VAS评分均低于A组,差异均有统计学意义(P<0.05),而B组、C组、D组患者的VAS评分比较差异均无统计学意义(P>0.05)。术后24 h,B组、C组、D组患者的NE、COR、AOPPs水平均低于A组,且D组低于B组和C组,差异均有统计学意义(P<0.05);B组、C组、D组患者的SOD水平均高于A组,且D组高于B组和C组,差异均有统计学意义(P<0.05)。术后48 h,B组、C组、D组患者的SBP、HR均低于A组,MAP、镇静良好率均高于A组,差异有统计学意义(P<0.05),而B组、C组、D组患者的SBP、HR、MAP、镇静良好率比较差异均无统计学意义(P>0.05)。四组患者的术后不良反应发生率比较差异均无统计学意义(P>0.05)。结论不同剂量艾司氯胺酮复合舒芬太尼均可显著减轻烧伤患者术后的疼痛程度,增强镇静效果,改善患者的血流动力学水平,其中1.5mg/kg艾司氯胺酮复合舒芬太尼更能减轻患者的应激反应,且安全性良好。
Objective To explore the application effect of different doses of esketamine combined with sufentanil in postoperative patient-controlled intravenous analgesia for burn patients.Method 104 burn patients admitted to the Zhangjiakou First Hospital from January 2022 to January 2023 were selected as the study objects.They were divided into group A,group B,group C and group D by random number table method,with 26 cases in each group.Group A was treated with 2μg/kg sufentanil PCIA after surgery.Group B was treated with 0.75 mg/kg esketamine and 1.5μg/kg sufentanil PCIA after surgery.Group C was treated with 1.0 mg/kg esketamine and 1.5μg/kg sufentanil PCIA after surgery.Group D was treated 1.5 mg/kg esketamine and 1.5μg/kg sufentanil PCIA after surgery.VAS scores at different time points after surgery,stress response indexes(NE,COR,SOD,AOPPs)before and after surgery,hemodynamic indexes(SBP,HR,MAP)before and after surgery,sedation effect 48 h after surgery,and the occurrence of postoperative adverse reactions in the four groups were compared and analyzed.Result At 12,24 and 48 h after surgery,the VAS scores in group B,group C and group D were lower than those in group A,with statistical significance(P<0.05),while there were no statistical significances in groups B,group C and group D(P>0.05).24 h after surgery,the levels of NE,COR and AOPPs in group B,group C and group D were lower than those in group A,and those in group D were lower than those in group B and group C,with statistical significance(P<0.05).The SOD level of group B,group C and group D was higher than that of group A,and group D was higher than that of group B and group C,the differences were statistically significant(P<0.05).48 h after surgery,SBP,HR in group B,group C and group D were lower than those in group A,and MAP,the rates of good sedation were higher than those in group A,with statistical significance(P<0.05),while there were no statistical significances in SBP,HR,MAP and the rates of good sedation in group B,group C and group D(P>0.05).There were no significant differences in the incidence of postoperative adverse reactions among the four groups(P>0.05).Conclusion Different doses of esketamine combined with sufentanil can significantly reduce the degree of postoperative pain in burn patients,and enhance the sedation effect,and improve the hemodynamic level of patients,among which 1.5 mg/kg esketamine combined with sufentanil can reduce the stress response better,with good safety.
作者
杨惠茹
刘永飞
李侃
张琰
马贞华
尹健
边兴花
蔡怿超
李佳
Yang Huiru;Liu Yongfei;Li Kan;Zhang Yan;Ma Zhenhua;Yin Jian;Bian Xinghua;Cai Yichao;Li Jia(Department of Anesthesiology,Zhangjiakou First Hospital,Zhangjiakou Hebei 075000,China;Fourth Department of General Surgery,Zhangjiakou First Hospital,Zhangjiakou Hebei 075000,China)
出处
《中国医刊》
CAS
2024年第3期284-288,共5页
Chinese Journal of Medicine
基金
河北省张家口市重点研发计划项目(2221216D)。
作者简介
通信作者:马贞华,E-mail:15532318755@163.com。
