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目的观察右美托咪定复合氯胺酮用于小儿烧伤换药的临床镇静效果与安全性。方法分别对20例小儿烧伤患者的两次换药使用不同的镇静方法 ,Ⅰ类和Ⅱ类。实验采用两阶段交叉设计,过程采用双盲法。监测静脉泵注前(T1)、泵注10 min后(T2)、换药开始1 min(T3)、10 min(T4)、换药结束(T5)患儿的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、动脉血氧饱和度(Sp O2)等指标,分析镇静评分,并且记录患儿的换药时间、体动时间、氯胺酮用量等,观察患儿苏醒躁动以及恶心呕吐情况,并且进行满意度评分。结果在T2~T5时,Ⅰ类镇静方法的HR慢于Ⅱ类镇静方法、MAP低于Ⅱ类镇静方法(P<0.05);在T1~T5时,两种镇静方法的RR、Sp O2差异没有统计学意义(P>0.05)。Ⅰ类镇静方法的苏醒躁动、恶心呕吐、满意度等评分均要高于Ⅱ类镇静方法 (P<0.05)。结论右美托咪定复合氯胺酮用于小儿烧伤换药镇静,可以保证患儿血流动力学指标稳定,不会影响患儿呼吸,并且可以提高患儿苏醒质量,保证了患儿的安全性。
Objective To observe the clinical sedation and safety of dexmedetomidine plus ketamine for pediatric burn dressing. Methods Twenty patients with pediatric burn patients were given different sedation methods, I and II respectively. The experiment adopts two-stage crossover design, the process adopts double-blind method. The heart rate (HR), mean arterial pressure (MAP), blood pressure and heart rate were measured in patients with venous pump (T1), 10 min after pump (T2), 1 min (T3), 10 min (MAP), respiratory rate (RR), arterial oxygen saturation (Sp O2) and other indicators, sedation score was analyzed, and the patient’s dressing time, body movement time, ketamine dosage, etc. observed in children with restlessness and nausea Vomiting, and satisfaction ratings. Results At T2 ~ T5, the HR of type Ⅰ sedation was lower than that of type Ⅱ sedation and MAP was lower than type Ⅱ sedation (P <0.05). There was no difference in RR and Sp O2 between T1 and T5 Statistical significance (P> 0.05). Type I sedation recovery awake, nausea and vomiting, satisfaction scores were higher than the type Ⅱ sedation (P <0.05). Conclusion Dexmedetomidine combined with ketamine for pediatric burn dressing sedation, can ensure that children with hemodynamic stability, will not affect children’s breathing, and can improve the quality of children’s wake and ensure the safety of children.