右美托咪定用于烧伤伴高血压患者削痂植皮术中的镇静效果分析
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摘要
目的探讨右美托咪定用于烧伤削痂植皮手术中的临床镇静效果。方法选取2014年1月—2017年12月在湖州市第一人民医院行削痂手术烧伤伴高血压患者60例,随机数字法分成对照组和治疗组,每组30例患者。入组患者术前20 min均静注0.5 mg盐酸戊乙奎醚,对照组患者进行常规手术麻醉,治疗组患者在常规手术麻醉基础上,在术前15 min静注右美托咪定。结果诱导后10 min,治疗组镇静评分高于对照组,氧饱和度低于对照组,治疗组呼吸频率高于对照组,组间差异均有统计学意义(均P<0.05)。对照组患者单位时间丙泊酚维持量为(3.9±0.8)mg/(kg·h),治疗组为(1.7±0.4)mg/(kg·h),对照组和治疗组氯胺酮维持剂量分别为(3.5±0.6)mg/(kg·h)和(1.4±0.3)mg/(kg·h),2组间差异有统计学意义(均P<0.05)。在削痂、取皮及植皮时刻,治疗组心率及收缩压显著低于对照组,组间差异有统计学意义(均P<0.05)。治疗组患者不良反应发生率比对照组低,手术后清醒时间明显比对照组短,组间差异有统计学意义(均P<0.05)。对照组和治疗组手术时间分别为(151.6±71.3)min和(161.8±69.3)min,差异无统计学意义(P>0.05)。结论静注右美托咪定注射液能够在镇静基础上节省异丙酚和氯胺酮药物剂量,在手术期间患者血流动力学及呼吸更稳定,手术后患者清醒时间较短,不良反应发生率降低。
Objective To investigate the clinical efficacy of Dexmedetomidine for sedation in tangential excision and skin grafting for burn treatment. Methods A total of 60 hypertension patients with burns undergoing tangential excision and skin grafting in our hospital from January 2014 to December 2017 were enrolled into this study and randomly divided into control group and treatment group with 30 patients in each group. All the selected patients were administrated with 0.5 mg penehyclidine hydrochloride intravenously 20 minutes before surgery. The control group received the routine surgical anesthesia, while the treatment group received intravenous injection of dexmedetomidine 15 min before the surgery on the basis of routine anesthesia. Results The level of sedation scores at 10 minutes after induction in the treatment group was higher than that in the control group, the oxygen saturation in the treatment group was lower than that in the control group, however, the respiratory rate in the treatment group was higher than that in the control group, the differences were statistically significant(all P<0.05). The maintenance dose of propofol per unit time was(3.9±0.8) mg/(kg·h) in the control group, and(1.7±0.4) mg/(kg·h) in the treatment group, of ketamine was(3.5±0.6) mg/(kg·h) in the control group and(1.4±0.3) mg/(kg·h) in the treatment group, respectively, the difference was statistically significant(all P<0.05). During the excision of the scab, skin harvest and skin grafting, the heart rate and systolic blood pressure in the treatment group was significantly lower than those in the control group, and the difference was statistically significant(all P<0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group, the l wake-up time after surgery was significantly shorter than that in the control group, and the differences was statistically significant(all P<0.05). The surgery duration of the control group and the treatment group were(151.6±71.3) min and(161.8±69.3) min, respectively, with no significant difference(P>0.05). Conclusion The intravenous infusion of dexmedetomidine can save the dose of propofol and ketamine on the base of sedation. The hemodynamics and respiration of the patients keep stablely during the operation. It can also shorten the waking-up time and decrease the incidence of adverse reaction.
Objective To investigate the clinical efficacy of Dexmedetomidine for sedation in tangential excision and skin grafting for burn treatment. Methods A total of 60 hypertension patients with burns undergoing tangential excision and skin grafting in our hospital from January 2014 to December 2017 were enrolled into this study and randomly divided into control group and treatment group with 30 patients in each group. All the selected patients were administrated with 0.5 mg penehyclidine hydrochloride intravenously 20 minutes before surgery. The control group received the routine surgical anesthesia, while the treatment group received intravenous injection of dexmedetomidine 15 min before the surgery on the basis of routine anesthesia. Results The level of sedation scores at 10 minutes after induction in the treatment group was higher than that in the control group, the oxygen saturation in the treatment group was lower than that in the control group, however, the respiratory rate in the treatment group was higher than that in the control group, the differences were statistically significant(all P<0.05). The maintenance dose of propofol per unit time was(3.9±0.8) mg/(kg·h) in the control group, and(1.7±0.4) mg/(kg·h) in the treatment group, of ketamine was(3.5±0.6) mg/(kg·h) in the control group and(1.4±0.3) mg/(kg·h) in the treatment group, respectively, the difference was statistically significant(all P<0.05). During the excision of the scab, skin harvest and skin grafting, the heart rate and systolic blood pressure in the treatment group was significantly lower than those in the control group, and the difference was statistically significant(all P<0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group, the l wake-up time after surgery was significantly shorter than that in the control group, and the differences was statistically significant(all P<0.05). The surgery duration of the control group and the treatment group were(151.6±71.3) min and(161.8±69.3) min, respectively, with no significant difference(P>0.05). Conclusion The intravenous infusion of dexmedetomidine can save the dose of propofol and ketamine on the base of sedation. The hemodynamics and respiration of the patients keep stablely during the operation. It can also shorten the waking-up time and decrease the incidence of adverse reaction.
引文
[1] NIE Y,LIU Y,LUO Q,et al.Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia:a randomised,placebo-controlled study[J].Eur J Anaesthesiol,2014,31(4):197-203.
[2] 王大龙,张海山,郑观荣,等.右美托咪定对大面积烧伤患者静脉全身麻醉切痂植皮术应激反应的影响[J].中国现代医学杂志,2014,24(20):73-77.
[3] 郝雪莲,孙媛,郭琼梅,等.右美托咪定对舒芬太尼用于小儿大面积烧伤削痂植皮术后镇痛的改良作用[J].中华麻醉学杂志,2016,36(4):456-458.
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[6] 孙岳.负压创面治疗技术联合削痂植皮治疗深度烧伤的疗效分析[D].济南:山东大学,2017.
[7] 朱志鹏,周红梅,张才军,等.右美托咪定复合氯胺酮全麻运用于烧伤患者削痂植皮术的可行性[J].中华全科医学,2014,12(3):362-364.
[8] YANG X M,LIU J,JI J,et al.Effects of dexmedetomidine on the deformability of erythrocytes in vitro and in anesthesia[J].Exp Ther Med,2014,7(6):1631-1634.
[9] 李翔,陈惠裕,李法印.右美托咪啶和咪达唑仑复合瑞芬太尼用于内镜黏膜下剥离术中镇静的比较[J].中华全科医师杂志,2013,12(11):931-933.
[10] 梁礼权,焦燕琴,王少林,等.右美托咪啶在(高血压)烧伤患者削痂植皮术中的镇静疗效观察[J].江西医药,2017,52(10):1051-1053.
[11] 何绮霞,卢燕,莫坚,等.不同剂量右美托咪定静脉泵注对切痂植皮术烧伤患者炎症反应的影响[J].山东医药,2016,56(1):89-92.
[12] SONG J,KIM W M,LEE S H,et al.Dexmedetomidine for sedation of patients undergoing elective surgery under regional anesthesia[J].Korean J Anesthsiol,2013(65):203-208.
[13] 徐燕,成建庆,葛叶盈,等.右美托咪定抑制慢性吸烟患者气管插管反应的临床研究[J].中华全科医师杂志,2014,13(6):499-501.
[14] 袁波,杨兴辉.小剂量右美托咪定和氯胺酮预注射对瑞芬太尼致全身麻醉后痛觉过敏的作用[J].江西医药,2016,51(7):701-703.
[15] CHANG Y,HUANG X,LIU Z,et al.Dexmedetomidine inhibits the secretion of high mobility group box 1 from lipopolysaccharide-acti-vated macrophages in vitro[J].J Surg Res,2013,181(2):308-314.
[16] 陈运良,熊朝晖,王晓斌,等.小剂量氯胺酮复合丙泊酚麻醉对电休克抽搐发作的影响[J].实用医学杂志,2013,29(3):459-461.
[17] FRIESEN R H,NICHOLS C S,TWITE M D,et al.The hemodynamic response to dexmedetomidine loading dose in children with and without pulmonaryhepertension[J].Anesth Analg,2013,117(4):953-959.
[2] 王大龙,张海山,郑观荣,等.右美托咪定对大面积烧伤患者静脉全身麻醉切痂植皮术应激反应的影响[J].中国现代医学杂志,2014,24(20):73-77.
[3] 郝雪莲,孙媛,郭琼梅,等.右美托咪定对舒芬太尼用于小儿大面积烧伤削痂植皮术后镇痛的改良作用[J].中华麻醉学杂志,2016,36(4):456-458.
[4] KIM S Y,CHANG C H,LEE J S,et al.Comparison of the efficacy of dexmedetomidine plus fentanyl patient-controlled analgesia with fentanyl patient-controlled analgesia for pain control in uterine artery embolization for symptomatic fibroid tumors or adenomyosis:a prospective,randomized study[J].J Vasc Interv Radiol,2013,24(6):779-786.
[5] 朱志鹏,周红梅,路建,等.右美托咪定对严重烧伤患者围术期炎症因子的影响[J].中华全科医学,2015,13(12):1944-1946.
[6] 孙岳.负压创面治疗技术联合削痂植皮治疗深度烧伤的疗效分析[D].济南:山东大学,2017.
[7] 朱志鹏,周红梅,张才军,等.右美托咪定复合氯胺酮全麻运用于烧伤患者削痂植皮术的可行性[J].中华全科医学,2014,12(3):362-364.
[8] YANG X M,LIU J,JI J,et al.Effects of dexmedetomidine on the deformability of erythrocytes in vitro and in anesthesia[J].Exp Ther Med,2014,7(6):1631-1634.
[9] 李翔,陈惠裕,李法印.右美托咪啶和咪达唑仑复合瑞芬太尼用于内镜黏膜下剥离术中镇静的比较[J].中华全科医师杂志,2013,12(11):931-933.
[10] 梁礼权,焦燕琴,王少林,等.右美托咪啶在(高血压)烧伤患者削痂植皮术中的镇静疗效观察[J].江西医药,2017,52(10):1051-1053.
[11] 何绮霞,卢燕,莫坚,等.不同剂量右美托咪定静脉泵注对切痂植皮术烧伤患者炎症反应的影响[J].山东医药,2016,56(1):89-92.
[12] SONG J,KIM W M,LEE S H,et al.Dexmedetomidine for sedation of patients undergoing elective surgery under regional anesthesia[J].Korean J Anesthsiol,2013(65):203-208.
[13] 徐燕,成建庆,葛叶盈,等.右美托咪定抑制慢性吸烟患者气管插管反应的临床研究[J].中华全科医师杂志,2014,13(6):499-501.
[14] 袁波,杨兴辉.小剂量右美托咪定和氯胺酮预注射对瑞芬太尼致全身麻醉后痛觉过敏的作用[J].江西医药,2016,51(7):701-703.
[15] CHANG Y,HUANG X,LIU Z,et al.Dexmedetomidine inhibits the secretion of high mobility group box 1 from lipopolysaccharide-acti-vated macrophages in vitro[J].J Surg Res,2013,181(2):308-314.
[16] 陈运良,熊朝晖,王晓斌,等.小剂量氯胺酮复合丙泊酚麻醉对电休克抽搐发作的影响[J].实用医学杂志,2013,29(3):459-461.
[17] FRIESEN R H,NICHOLS C S,TWITE M D,et al.The hemodynamic response to dexmedetomidine loading dose in children with and without pulmonaryhepertension[J].Anesth Analg,2013,117(4):953-959.