小剂量瑞芬太尼对糖尿病足溃疡清创换药疼痛和应激反应的影响
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摘要
目的探讨小剂量瑞芬太尼对糖尿病足溃疡(DFU)清创换药疼痛和应激反应的影响。方法将DFU患者64例分为试验组(R组)和对照组(C组),各32例。清创换药前5 min,试验组静脉注射瑞芬太尼0.08μg/(kg·min)直至换药结束,对照组静脉注射等剂量0.9%氯化钠注射液。结果 C组揭开纱布时(T_1)、清除坏死组织时(T_2)的平均动脉压(MAP)、心率(HR)和视觉模拟评分(VAS)[(114.2±11.3) mmHg,(116.3±12.4) mmHg;(92.3±7.9)次/分,(94.6±8.6)次/分;(5.8±1.4)分,(6.3±1.2)分],明显高于组内覆盖治疗创面药物时(T_3)、清创换药结束后2 h(T_4)和同时点R组[(96.6±9.6) mmHg,(97.8±10.3) mmHg;(71.5±8.2)次/分,(73.4±8.6)次/分;(2.9±1.3)分,(3.0±1.0)分; P <0.05]; R组Likert五分量表对清创换药的满意度评价优于C组(P <0.05);C组高血压发生率为37.50%,明显高于R组的12.50%(P <0.05)。结论 0.08μg/(kg·min)瑞芬太尼用于DFU清创换药,可减轻患者的疼痛,维持血流动力学平稳,提高患者满意度。
Objective To investigate the effect of low-dose remifentanil on pain and stress response in debridement and dressing change in patients with diabetic foot ulcers(DFU).Methods Totally 64 patients with DFU were randomly divided into the experimental group(group R) and the control group(group C),32 cases in each group.5 min before debridement and dressing change,the patients in the experimental group were given 0.08 μg/(kg·min) remifentanil intravenously until the end of dressing change,while the patients in the control group were given the equal dose of 0.9% Sodium Chloride Injection intravenously.Results When the gauze was uncovered(T_1) and necrotic tissue was removed(T_2),the mean arterial pressure(MAP),heart rate(HR) and visual analogue scale(VAS) scores in group C were(114.2 ± 11.3) mmHg and(116.3 ± 12.4) mm Hg,(92.3 ± 7.9) times/min and(94.6 ± 8.6) times/min,(5.8 ± 1.4) points and(6.3 ± 1.2) points,which were significantly higher than those in each group when drug covered the surface of wound(T_3) and 2 h after debridement and dressing change(T_4), and also significantly higher than(96.6 ± 9.6) mmHg and(97.8 ± 10.3) mmHg,(71.5 ±8.2) times/min and(73.4 ± 8.6) times/min,(2.9 ± 1.3) points and(3.0 ± 1.0) points at the same time points in group R(P < 0.05).The satisfaction evaluation of debridement and dressing change of Likert five-scale in group R was better than that in group C(P < 0.05).The incidence rate of hypertension in group C was 37.50%, which was significantly higher than 12.50% in group R(P < 0.05).Conclusion 0.08 μg/(kg · min) remifentanil can relieve pain, maintain stable hemodynamics and improve the satisfaction degree of patients during debridement dressing in patients with DFU.
Objective To investigate the effect of low-dose remifentanil on pain and stress response in debridement and dressing change in patients with diabetic foot ulcers(DFU).Methods Totally 64 patients with DFU were randomly divided into the experimental group(group R) and the control group(group C),32 cases in each group.5 min before debridement and dressing change,the patients in the experimental group were given 0.08 μg/(kg·min) remifentanil intravenously until the end of dressing change,while the patients in the control group were given the equal dose of 0.9% Sodium Chloride Injection intravenously.Results When the gauze was uncovered(T_1) and necrotic tissue was removed(T_2),the mean arterial pressure(MAP),heart rate(HR) and visual analogue scale(VAS) scores in group C were(114.2 ± 11.3) mmHg and(116.3 ± 12.4) mm Hg,(92.3 ± 7.9) times/min and(94.6 ± 8.6) times/min,(5.8 ± 1.4) points and(6.3 ± 1.2) points,which were significantly higher than those in each group when drug covered the surface of wound(T_3) and 2 h after debridement and dressing change(T_4), and also significantly higher than(96.6 ± 9.6) mmHg and(97.8 ± 10.3) mmHg,(71.5 ±8.2) times/min and(73.4 ± 8.6) times/min,(2.9 ± 1.3) points and(3.0 ± 1.0) points at the same time points in group R(P < 0.05).The satisfaction evaluation of debridement and dressing change of Likert five-scale in group R was better than that in group C(P < 0.05).The incidence rate of hypertension in group C was 37.50%, which was significantly higher than 12.50% in group R(P < 0.05).Conclusion 0.08 μg/(kg · min) remifentanil can relieve pain, maintain stable hemodynamics and improve the satisfaction degree of patients during debridement dressing in patients with DFU.
引文
[1]卫东,杜丽萍,张家建.封闭负压引流联合生物敷料对糖尿病足溃疡创面植皮后血管新生、炎症反应的影响[J].海南医学院学报,2017,23(15):2071-2074.
[2]EVERETT E,MATHIOUDAKIS N.Update on management of diabetic foot ulcers[J].Ann N Y Acad Sci,2018,1411(1):153-165.
[3]王依贵,方利,龚敏,等.术后疼痛管理循证实践的现状水平及影响因素[J].重庆医学,2016,45(12):1724-1726.
[4]HORGAS AL.Pain Management in Older Adults[J].Nurs Clin North Am,2017,52(4):e1-e7.
[5]陈敏华,朱音,叶菁.丁卡因用于糖尿病足溃疡伴疼痛患者换药止痛的临床观察[J].浙江中西医结合杂志,2016,26(1):64-65.
[6]张伟,孔垂霖,周东红.小剂量瑞芬太尼麻醉在结肠镜检查术中的应用[J].皖南医学院学报,2016,35(2):177-178.
[7]肖庆旺,张伟,李爱华,等.瑞芬太尼复合丙泊酚用于老年患者清醒状态下膀胱镜检查的可行性研究[J].现代中西医结合杂志,2017,26(32):3635-3637.
[8]柴林,刘智慧,郑智文,等.靶控输注依托咪酯联合瑞芬太尼对老年手术患者机体免疫及应激反应指标的影响[J].中国药房,2017,28(15):2036-2039.
[9]谢东武.瑞芬太尼联合依托咪酯对无痛纤维支气管镜检查过程中应激反应的影响[J].海南医学院学报,2017,23(8):1127-1130.
[10]旷小艳,陆璐,朱均梅.院后上门指导对糖尿病足患者的心理状况及治疗依从性的研究[J].国际护理学杂志,2015,34(20):2828-2830.
[11]冯泽会,龚芸,兰红敏,等.老年糖尿病足清创术后患者延续护理效果观察[J].护理学报,2017,24(2):70-72.
[12]刘民腔,李仁宰,何俊永,等.意识指数监测联合小剂量瑞芬太尼在无痛人流术中的安全性[J].实用医学杂志,2018,34(7):1179-1182.
[13]BOUILLON T,BRUHN J,RADU-RADULESCU L,et al.Amodel of the ventilatory depressant potency of remifentanil in the non-steady state[J].Anesthesiology,2003,99(4):779-787.
[14]周仁龙,王珊娟,杭燕南,等.瑞芬太尼对老年病人呼吸功能的影响[J].中华麻醉学杂志,2007,27(2):111-113.
[15]陈勇,梁敏,欧阳碧山,等.瑞芬太尼引起全麻患者呼吸抑制的量效关系[J].中华麻醉学杂志,2008,28(3):211-213.
[16]姚峥,徐静,陈莲华.瑞芬太尼静脉连续输注在儿童和成人保留自主呼吸的剂量[J].上海医学,2012,35(10):833-836.
[17]赵晓峥,张曼,赵庆阳.舒芬太尼复合丙泊酚对小面积微创吸脂手术麻醉的效果及安全性评价[J].中国药业,2017,26(13):69-71.
[18]邢第林,刘娟,林家国.芬太尼、舒芬太尼、瑞芬太尼全身麻醉诱导对循环干扰的比较[J].重庆医学,2015,44(2):258-260.
[2]EVERETT E,MATHIOUDAKIS N.Update on management of diabetic foot ulcers[J].Ann N Y Acad Sci,2018,1411(1):153-165.
[3]王依贵,方利,龚敏,等.术后疼痛管理循证实践的现状水平及影响因素[J].重庆医学,2016,45(12):1724-1726.
[4]HORGAS AL.Pain Management in Older Adults[J].Nurs Clin North Am,2017,52(4):e1-e7.
[5]陈敏华,朱音,叶菁.丁卡因用于糖尿病足溃疡伴疼痛患者换药止痛的临床观察[J].浙江中西医结合杂志,2016,26(1):64-65.
[6]张伟,孔垂霖,周东红.小剂量瑞芬太尼麻醉在结肠镜检查术中的应用[J].皖南医学院学报,2016,35(2):177-178.
[7]肖庆旺,张伟,李爱华,等.瑞芬太尼复合丙泊酚用于老年患者清醒状态下膀胱镜检查的可行性研究[J].现代中西医结合杂志,2017,26(32):3635-3637.
[8]柴林,刘智慧,郑智文,等.靶控输注依托咪酯联合瑞芬太尼对老年手术患者机体免疫及应激反应指标的影响[J].中国药房,2017,28(15):2036-2039.
[9]谢东武.瑞芬太尼联合依托咪酯对无痛纤维支气管镜检查过程中应激反应的影响[J].海南医学院学报,2017,23(8):1127-1130.
[10]旷小艳,陆璐,朱均梅.院后上门指导对糖尿病足患者的心理状况及治疗依从性的研究[J].国际护理学杂志,2015,34(20):2828-2830.
[11]冯泽会,龚芸,兰红敏,等.老年糖尿病足清创术后患者延续护理效果观察[J].护理学报,2017,24(2):70-72.
[12]刘民腔,李仁宰,何俊永,等.意识指数监测联合小剂量瑞芬太尼在无痛人流术中的安全性[J].实用医学杂志,2018,34(7):1179-1182.
[13]BOUILLON T,BRUHN J,RADU-RADULESCU L,et al.Amodel of the ventilatory depressant potency of remifentanil in the non-steady state[J].Anesthesiology,2003,99(4):779-787.
[14]周仁龙,王珊娟,杭燕南,等.瑞芬太尼对老年病人呼吸功能的影响[J].中华麻醉学杂志,2007,27(2):111-113.
[15]陈勇,梁敏,欧阳碧山,等.瑞芬太尼引起全麻患者呼吸抑制的量效关系[J].中华麻醉学杂志,2008,28(3):211-213.
[16]姚峥,徐静,陈莲华.瑞芬太尼静脉连续输注在儿童和成人保留自主呼吸的剂量[J].上海医学,2012,35(10):833-836.
[17]赵晓峥,张曼,赵庆阳.舒芬太尼复合丙泊酚对小面积微创吸脂手术麻醉的效果及安全性评价[J].中国药业,2017,26(13):69-71.
[18]邢第林,刘娟,林家国.芬太尼、舒芬太尼、瑞芬太尼全身麻醉诱导对循环干扰的比较[J].重庆医学,2015,44(2):258-260.