右美托咪定联合小剂量氯胺酮预防重度烧伤植皮术瑞芬太尼麻醉后痛觉过敏的效果分析

目的 探讨右美托咪定联合小剂量氯胺酮在重度烧伤患者植皮术中瑞芬太尼麻醉后痛觉过敏中的应用效果.方法 2019年3月至2020年3月在我院接受植皮手术治疗的98例重度烧伤患者,根据麻醉用药不同分为研究组(右美托咪定联合小剂量氯胺酮)及对照组(右美托咪定)各49例.比较两组手术相关指标、术后2、4、8、12及24h的视觉模...

Analysis of the effect of dexmedetomidine combined with low-dose ketamine in preventing hyperalgesia after remifentanil anesthesia in patients with severe burns and skin grafting

Objective To explore the application effect of dexmedetomidine combined with low-dose ketamine in preventing hyperalgesia after remifentanil anesthesia during dermatoplasty of patients with severe burns.Methods Clinical data of 98 patients with severe burns who underwent dermatoplasty in our hospital from March 2019 to March 2020 were retrospectively collected.According to anesthesia medication,they were divided into a study group treated with dexmedetomidine combined with low-dose ketamine(n=49)and a control group treated with dexmedetomidine(n=49).Surgery related indicators,visual analogue scale(VAS)scores after 2h,4h,8h,12h and 24h of surgery,heart rate(HR)and mean arterial pressure(MAP)before induction of anesthesia(T0),after induction of anesthesia(T1),after intubation(T2),during operation(T3),at time of tracheal tube removal(T4),and after 10 minutes of tracheal tube removal(T5)were compared between the two groups.The sedation status was evaluated by using Ramsay sedation classification after 30 minutes of extubation.The adverse reactions were also compared between the two groups.Results There was no significant difference in skin graft area,intraoperative blood loss,operation time,wake-up time,and removal time of tracheal tube between the two groups(P>0.05).After treatment,the pain scores of the two groups were decreased gradually,and the VAS scores at different time after treatment of the study group were lower than those of the control group(P<0.05).The rate of good sedation in the study group was 87.86%,which was higher than 71.43%in the control group after 30 minutes of extubation(P<0.05).After induction,the HR and MAP levels of the two groups were increased first and then decreased(P<0.05).Except for the MAP at T1,the HR and MAP levels in the study group were lower than those in the control group from T1 to T5(P<0.05).The incidence of pain and allergy in the control group which was significantly higher than in the study group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine combined with low-dose ketamine is effective in preventing hyperalgesia after remifentanil anesthesia during dermatoplasty of patients with severe burns.It can effectively reduce the postoperative pain of patients and maintain hemodynamic stability,and improve the postoperative hyperalgesia.It has certain promotion value.