摘要
目的探讨七氟醚吸入镇静镇痛应用于大面积烧伤患儿换药的安全性以及有效性。方法采用前瞻性随机对照研究方法。2020年3月—2023年1月,昆明市儿童医院烧伤整形外科收治216例符合入选标准的大面积烧伤患儿。采用随机数字表法将患儿分为七氟醚组和布洛芬组,剔除脱落患儿后,七氟醚组中最终纳入103例患儿,其中男67例、女36例,年龄1(1,2)岁;布洛芬组最终纳入98例患儿,其中男67例、女31例,年龄1(1,2)岁。七氟醚组患儿换药时吸入七氟醚镇静镇痛,布洛芬组患儿换药前口服布洛芬镇痛。监测并记录患儿换药开始前30 min,清创后即刻、换药完毕后30 min的心率、平均动脉压(MAP)、经皮动脉血氧饱和度(SpO2);分别采用面部表情、腿部动作、活动度、哭闹和可安慰性量表和Ramsay镇静量表评估患儿换药开始前30 min、清创后即刻、换药完毕后30 min的疼痛强度及镇静程度;记录换药时间与住院期间总换药次数;在患儿出院时,采用休斯敦疼痛情况调查表调查换药医师及1名患儿家属对患儿换药过程中镇痛效果的满意度;监测记录患儿换药过程中发生的呼吸抑制、低氧血症等不良反应。对数据行独立样本t检验、重复测量方差分析、Wilcoxon秩和检验、χ^(2)检验、Fisher确切概率法检验。结果换药开始前30 min和换药完毕后30 min,2组患儿心率、MAP、SpO2比较,差异均无统计学意义(P>0.05)。清创后即刻,与布洛芬组比较,七氟醚组患儿心率、MAP均明显降低(t值分别为8.10、4.37,P<0.05),而SpO2明显升高(t=21.77,P<0.05)。换药开始前30 min和换药完毕后30 min,2组患儿疼痛强度评分、镇静程度评分比较,差异均无统计学意义(P>0.05)。清创后即刻,与布洛芬组比较,七氟醚组患儿疼痛强度评分明显降低,而镇静程度评分明显升高(t值分别为42.87、72.45,P<0.05)。七氟醚组患儿的换药时间、住院期间总换药次数分别为
Objective To explore the safety and effectiveness of the application of sevoflurane inhalation sedation and analgesia during dressing changes in children with extensive burns.Methods A prospective randomized controlled research was conducted.From March 2020 to January 2023,216 children with extensive burns who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Kunming Children's Hospital.According to the random number table,the children were divided into sevoflurane group and ibuprofen group,with 103 cases left in sevoflurane group(67 males and 36 females,aged 1(1,2)years),and 98 cases left in ibuprofen group(67 males and 31 females,aged 1(1,2)years)after the exclusion of several dropped-out children.Children in sevoflurane group received sevoflurane inhalation for sedation and analgesia during dressing changes,while those in ibuprofen group took oral ibuprofen for analgesia before dressing changes.The heart rate,mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)of the children were monitored and recorded at 30 minutes before the start of dressing changes,immediately after debridement,and at 30 minutes after the completion of dressing changes.The face,legs,activity,cry,and consolability scale and Ramsay sedation scale were used to evaluate the pain intensity and degree of sedation,respectively,at 30 minutes before the start of dressing changes,immediately after debridement,and at 30 minutes after the completion of dressing changes.The duration of dressing changes and the total number of dressing changes during hospitalization were recorded.The Houston Pain Outcome Instrument questionnaire was used to assess the satisfaction of the dressing-changing surgeons and a family member of the child with the analgesic effects during the process of dressing change when the children were discharged from the hospital.The occurrence of adverse reactions such as respiratory depression and hypoxemia that occurred during the process of dressing change were monitor
作者
张梦思
黄磊
朱辉
麻艺群
付晋凤
Zhang Mengsi;Huang Lei;Zhu Hui;Ma Yiqun;Fu Jinfeng(Department of Burns and Plastic Surgery,Kunming Children's Hospital,Kunming 650031,China;Sedative and Analgesic Center,Kunming Children's Hospital,Kunming 650031,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2023年第11期1014-1020,共7页
Chinese Journal of Burns And Wounds
基金
昆明市卫生健康委员会卫生科研课题项目(2022-04-03-001)。
关键词
烧伤
儿童
疼痛
深度镇静
镇痛
Burns
Child
Pain
Deep sedation
Analgesia
