目的:探讨亚麻醉剂量氯胺酮复合舒芬太尼用于烧伤切痂植皮术后患者自控静脉镇痛(PCIA)的安全性、可行性及镇痛效果.方法:选取择期烧伤切痂植皮术患者90例,根据术后PCIA药物配比方法分为Sl组、S2组和KS组,每组30例,S1组配方为舒芬太尼2μg/kg,S2组为舒芬太尼2.5μg/kg,KS组为舒芬太尼2μg/kg合氯胺酮0.1 mg/(kg·h),3组均加入盐酸格拉司琼6 mg,生理盐水稀释至200 mL.均在手术结束30 min给予负荷量5 mL,记录术后2 h、8 h、24 h、48 h的视觉模拟镇痛评分、布氏舒适镇痛评分及Ramsay镇静评分,观察生命体征变化,观察和记录48 h使用PCIA泵期间的不良反应发生情况和有效按压总次数.结果:3组术后各时间点BCS评分、生命体征比较差异无统计学意义(P>0.05).KS组各时间点VAS评分分别为(1.8±0.9)分、(1.6±0.6)分、(1.6±0.8)分、(1.5±0.6)分;S2组各时间点VAS评分分别为(2.0±0.8)分、(1.8±0.9)分、(1.9±0.9)分、(1.7±0.8)分,均明显低于S1组[分别为(3.2±1.0)分、(2.8±1.1)分、(2.7±0.7)分、(2.5±0.9)分];KS组各时间点VAS评分明显低于S2组.KS组各时间点Ramsay镇静评分[分别为(3.0±1.0)分、(2.9±0.9)分、(2.9±1.1)分、(3.0±0.8)分]明显高于S1组[分别为(1.8±0.8)分、(1.9±1.0)分、(2.0±0.7)分、(2.0±0.8)分]与S2组[分别为(2.4±1.0)分、(2.4±1.1)分、(2.5±1.0)分、(2.5±0.9)分].KS组与S2组术后48 h内PCIA有效按压总次数分别为(10.3±2.5)次和(6.7±1.9)次,明显少于S1组[(3.9±1.3)次].3组术后48 h均未出现呼吸抑制、尿潴留等不良反应;3组皮肤瘙痒发生率相近(P>0.05);KS组、S1组恶心呕吐与嗜睡发生率分别为(3/30、1/30)和(5/30、2/30),明显低于S2组(12/30、9/30).结论:相比于单独使用舒芬太尼,对烧伤切痂植皮患者应用亚麻醉剂量氯胺酮复合舒芬太尼进行PCIA的镇静、镇痛效果更为充分,且使用期间不良反应发生率低,安全可靠.%Objective To discuss the safety, feasibility and the analgesic effect of subanesthetic dose of ketamine combined sufentanil for patient-controlled intravenous analgesia (PCIA) after burn escharectomy and skingrafting operation. Methods A total of 90 patients, diagnosed and treated in accordance with the inclu-sion criteria of patients with burn escharectomy and skingrafting operation, ASA grade II to III, aged 21 to 52 years old, were divided into S1 group, S2 group and KS group according to the method of postoperative PCIA drug compatibility. The analgesic formula in S1 group was for 2 μg/kg sufentanil, 2.5 μg/kg sufentanil for S2 group and 2 μg/kg sufentanil + ketamine 0.1 mg/(kg·h) for KS group. Granisetron hydrochloride 6 mg was added to formula for three groups. All patients were given 5 mL loading dose of analgesic formula at 30 min postopera-tion. Visual analogue pain score (VAS score), Brandt comfort score (BCS score) and Ramsay score were recorded at 2 h, 8 h, 24 h and 48 h after operation. Vital signs, including the mean arterial pressure, heart rate and pulse oxygen saturation changes were observed. Adverse reactions were observed and recorded 48 h during PCIA peri-od. The effective compression numbers were recorded also. Results There was no significant difference in the BCS scores and vital signs among three groups. VAS scores of KS group at each time point were (1.8±0.9), (1.6± 0.6), (1.6 ± 0.8), (1.5 ± 0.6); VAS scores of S2 group at each time point were (2 ± 0.8), (1.8 ± 0.9), (1.9 ± 0.9), (1.7 ± 0.8), significantly lower than that in group S1 [(3.2 ± 1.0), (2.8 ± 1.1), (2.7 ± 0.7), (2.5 ± 0.9),respectively]. VAS score of KS group at each time point was significantly lower than that of S2 group. Ramsay score of KS group at each time point (3.0±1.0, 2.9±0.9, 2.9±1.1, 3±0.8,re-spectively) was significantly higher than that of S1 group (1.8 ± 0.8, 1.9 ± 1.0, 2.0 ± 0.7, 2.0 ± 0.8,respective-ly) and S2 group (2.4±1.0, 2.4±1.1, 2.5±1.0, 2.5±0.9, respectively). Total effective compression numbers during 48 h postoperation of KS group and S2 group were (10.3 ± 2.5) and (6.7 ± 1.9), significantly less than S1 Group [(3.9 ± 1.3), P<0.05. ]. Patients in three groups showed no adverse reaction of respiratory depression and urinary retention. The incidence of skin pruritus in three groups was similar. The incidence of mausea and vomitting and lethargy in KS group and S1 group was sig-nificantly lower than that in S2 group. Conclusion Compared to the use of sufentanil alone to burn escharec-tomy and skingrafting, subanesthetic dose of ketamine combined with sufentanil has better analgesic effect with lower incidence of adverse reactions.
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