丙泊酚联合芬太尼自控镇痛在烧伤患者换药中的应用

目的 研究丙泊酚与芬太尼联合自控镇痛（PCA）在烧伤患者换药中的应用.方法 ASAⅠ或Ⅱ级,烧伤面积20%～50%的Ⅱ～Ⅲ度烧伤患者64例,随机数字表法分为芬太尼组（F组）和芬太尼＋丙泊酚组（FP组）,每组又随机分两亚组：F1、F2、FP1和FP2组,每组18例.F组：换药前5min静脉注射芬太尼1μg/kg.自控镇痛：芬太尼浓度为10μg/ml,维持为2ml/h,锁定时间10min,每次按压给定量为2ml和3ml;FP组：换药前5min静脉注射芬太尼1μg/kg,3min后靶控输注（TCI）丙泊酚,血浆浓度达1.5μg/kg后开始换药,镇痛泵同F组.记录每10min平均按压次数,给药次数和计算按压次数/给药次数比值;采用VAS法进行疼痛评分,评定手术医生和患者满意度及不良事件情况.结果 换药中平均VAS评分、每10min平均按压数、按压数/给药数比值F1组显著高于F2组 ,PF1组显著高于PF2组,F2组和PF1组差异无统计学意义.PF1和PF2组患者满意度和眩晕发生率较F1和F2组显著增高（P＜0.01）,且恶心呕吐发生率显著低于PF1和PF2组（P＜0.05）.PF2组3例出现呼吸抑制.结论 丙泊酚联合芬太尼PCA在烧伤患者换药中是安全可行的;芬太尼1μg/kg负荷量后PCA,最佳剂量是持续2ml/h,按压需要量2ml（20μg）,锁定时间10min.

Patient-controlled analgesia with fentanyl and propofol sedation for burn dressing changes

Objective To investigate the feasibility of patient-controlled analgesia （PCA） with fentanyl and propofol seda- tion for burn dressing changes. Methods Sixty-four patients with ASA grade I ~ II , who had thermal burns of 20N50% 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 of fentanyl 1 μg/kg I.V 5 min before the procedure; group PF received intra- venous infusion of fentanyl and target controlled infusion with propofol, when plasma concentrations reached to 1 μg/kg for 2 rain, the procedure was started. The patients were allocated to receive on-demand analgesia with PCA-fentanyl demand doses 20 μ g （F1, FP1） or 30 μg （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 μ ug after an IV initial loading dose of 1 μ g/kg, maintaining 2ml/h with a lockout interval of 10 rain, the combination of PCA with propofol for sedation is safe and feasible.