浙江医学2011，Vol.33Issue(3)：344-346,3.
丙泊酚联合芬太尼自控镇痛在烧伤患者换药中的应用
Patient-controlled analgesia with fentanyl and propofol sedation for burn dressing changes
王明仓 1陈玲阳 1项海飞 1曹东航 1叶礼岳2
作者信息
- 1. 317000,浙江省台州医院麻醉科
- 2. 317000,浙江省台州医院烧伤科
- 折叠
摘要
Abstract
Objective To investigate the feasibility of patient- controlled analgesia (PCA) with fentanyl and propofol sedation for burn dressing changes. Methods Sixty- four patients with ASA grade Ⅰ ～ Ⅱ , who had thermal burns of 20～50％ of total body surface area and were scheduled for burn dressing changes, were randomly divided into group F and group FP with 32 in each group. Group F received an initial loading dose offentanyl 1 μg/kg I.V5 min before the procedure; group PF received intravenous infusion offentanyl and target controlled infusion with propofol, when plasma concentrations reached to 1 μg/kg for 2 min,the procedure was started. The patients were allocated to receive on-demand analgesia with PCA-fentanyl demand doses 20μg (F1, FP1)or 30μg (F2, FP2).The demand dose was delivered intravenously at a constant rate by a PCA pump with a 10- min lockout interval and maintaining speed of 2ml/h. The demand per 10min, delivery per 10min and demand/delivery ratio were recorded, pain intensity was examined by the VAS score, doctor and patents satisfactory were assessed. Incidence of postoperative nausea and vomiting, dizziness, respiratory depression and hypotension were also recorded. Results During the dressing change procedure, mean VAS scores, demands made per 10min, delivered per 10min and demand/delivery ratio in the group F1 were significantly higher than those in group F2, those in group PF1 were significantly higher than those in group PF2 (P＜0.01),and there were no differences between those in F2 group and FP1 group (P＞0.05). The satisfaction of patients and incidence of dizziness in groups PF1 and PF2 were significantly higher than those in groups F1 and F2 (P＜0.01); while the incidence of nausea and vomiting groups in PF1 and PF2 were also significantly higher than those in groups F1 and F2 (P＜0.01). Three patients presented respiratory depression in group FP2. Conclusion The optimal PCA- fentanyl demand dose in our study was 2 μug afteran Ⅳ initial loading dose of 1 μg/kg, maintaining 2ml/h with a lockout interval of 10 min, the combination of PCA with propofol for sedation is safe and feasible.关键词
芬太尼/自控镇痛/镇静/烧伤换药引用本文复制引用
王明仓,陈玲阳,项海飞,曹东航,叶礼岳..丙泊酚联合芬太尼自控镇痛在烧伤患者换药中的应用[J].浙江医学,2011,33(3):344-346,3.
