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Title: [Observation on safety and effects of analgesic and sedative treatment in severely burned patients during shock stage].
Author: Li RB, Chen Q, Zhang HY, Deng HA, Guo GH, Mao YG, Fu ZH.
Journal: Zhonghua Shao Shang Za Zhi; 2018 Apr 20; 34(4):197-202. PubMed ID: 29690736.
Abstract:
Objective: To observe the safety and effects of application of analgesic and sedative drugs in severely burned patients during shock stage. Methods: One hundred and eighty patients with severe burns, conforming to the study criteria, were admitted to our unit from August 2014 to August 2016. Patients were divided into analgesia and sedation group and control group according to whether receiving analgesic and sedative treatment or not, with 90 cases in each group. Patients in control group received conventional treatment, while those in analgesia and sedation group received analgesic and sedative treatment for 24 hours besides conventional treatment. Before and at drug administration hour 2, 8, 16, and 24, pain degree of patients in two groups was scored by visual analogue scale (VAS). At drug administration hour 2, 8, 16, and 24, sedation degree of patients in two groups was scored by richmond agitation sedation scale, and the success rate of sedation was calculated. Mental state of patients within 24 hours of drug administration was observed, while pulse oxygen saturation (SpO(2)), respiratory rate, heart rate, and blood pressure were observed and dynamically evaluated every 2 hours. The accidental extubation, tachycardia, hypertension, hypoxia, bradycardia, hypotension, urinary retention, and respiratory depression of patients within 24 hours of drug administration were monitored and recorded. Data were processed with analysis of variance for repeated measurement, one-way analysis of variance, t test, chi-square test, Wilcoxon rank sum test, and Fisher's exact probability test. Results: (1) The VAS scores of patients in two groups were close before drug administration (t=0.675, P>0.05). The VAS scores of patients in analgesia and sedation group at drug administration hour 2, 8, 16, and 24 were (3.8±0.4), (3.9±0.6), (3.9±0.5), and (3.9±0.9) points, respectively, significantly lower than (6.0±0.9), (6.0±1.2), (6.2±0.6), and (6.3±0.4) points in control group (t=0.785, 0.730, 0.805, 0.895, P<0.05). The success rate of sedation of patients in analgesia and sedation group at drug administration hour 2, 8, 16, and 24 were 91.1% (82/90), 86.7% (78/90), 93.3% (84/90), and 90.0% (81/90), respectively, significantly higher than 7.8% (7/90), 6.7% (6/90), 14.4% (13/90), and 5.6% (5/90) in control group (Z=8.035, 7.946, 8.129, 8.014, P<0.05). (2) The respiratory rate of patients in analgesia and sedation group at drug administration hour 8, 16, and 24 were (15.78±0.69), (16.08±0.59), and (16.21±0.20) times per minute, and the heart rate were (87±9), (83±7), and (76±9) times per minute, respectively, significantly lower than (16.80±0.81), (17.09±0.50), and (17.02±0.61) times per minute and (89±8), (86±7), and (85±6) times per minute in control group (t=7.655, 7.022, 6.536, -6.931, -7.053, -10.196, P<0.01). There were no statistically significant difference in SpO(2), systolic blood pressure, and diastolic blood pressure before and at drug administration hour 2, 8, 16, and 24 between the two groups (t=3.417, -2.894, -6.501, -3.719, -4.573, 2.336, 3.315, 0.942, -1.583, 1.907, 1.147, -0.968, 0.931, -1.682, 1.076, P>0.05). (3) The rates of respiratory depression, hypoxia, bradycardia, urinary retention, and hypotension of patients in the two groups were close (χ(2)=0.310, P>0.05). The rates of hypertension, accidental extubation, and tachycardia of patients in analgesia and sedation group were significantly lower than those in control group (χ(2)=16.364, 5.143, 73.309, P<0.05 or P<0.01). Conclusions: Proper application of analgesic and sedative drugs in severely burned patients during shock stage has good clinical effect with low incidence rates of complications. 目的： 观察镇痛镇静药物在重症烧伤患者休克期应用的安全性及其疗效。 方法： 2014年8月—2016年8月，笔者单位收治符合入选标准的重症烧伤患者180例。根据休克期是否行镇痛镇静治疗，分为镇痛镇静组和对照组，每组90例。对照组患者采用常规治疗，镇痛镇静组患者在常规治疗的基础上采用镇痛镇静治疗24 h。给药前和给药2、8、16、24 h，采用视觉模拟评分(VAS)法对2组患者疼痛程度进行评分；给药2、8、16、24 h，采用躁动镇静评分量表对2组患者镇静程度进行评分，并计算镇静成功率。观察患者给药24 h内精神状态，每隔2小时观察及动态评估脉搏血氧饱和度(SpO(2))、呼吸频率、心率、血压。监测并记录患者给药24 h内意外拔管、心动过速、高血压、缺氧、心动过缓、低血压、尿潴留、呼吸抑制的发生情况。对数据行重复测量方差分析、单因素方差分析、t检验、χ(2)检验、Wilcoxon秩和检验及Fisher确切概率法检验。 结果： (1)2组患者给药前VAS评分相近(t＝0.675，P>0.05)。镇痛镇静组患者给药2、8、16、24 h的VAS评分分别为(3.8±0.4)、(3.9±0.6)、(3.9±0.5)、(3.9±0.9)分，明显低于对照组的(6.0±0.9)、(6.0±1.2)、(6.2±0.6)、(6.3±0.4)分(t＝0.785、0.730、0.805、0.895，P<0.05)。镇痛镇静组患者给药2、8、16、24 h镇静成功率分别为91.1%(82/90)、86.7%(78/90)、93.3%(84/90)、90.0%(81/90)，明显高于对照组的7.8%(7/90)、6.7%(6/90)、14.4%(13/90)、5.6%(5/90)(Z＝8.035、7.946、8.129、8.014，P<0.05)。(2)镇痛镇静组患者给药8、16、24 h呼吸频率分别为(15.78±0.69)、(16.08±0.59)、(16.21±0.20)次/min，心率分别为(87±9)、(83±7)、(76±9)次/min，明显低于对照组的(16.80±0.81)、(17.09±0.50)、(17.02±0.61)次/min和(89±8)、(86±7)、(85±6)次/min(t＝7.655、7.022、6.536、－6.931、－7.053、－10.196，P<0.01)。2组患者给药前及给药2、8、16、24 h SpO(2)、收缩压及舒张压比较，差异均无统计学意义(t＝3.417、－2.894、－6.501、－3.719、－4.573、2.336、3.315、0.942、－1.583、1.907、1.147、－0.968、0.931、－1.682、1.076，P>0.05)。(3)2组患者给药期间呼吸抑制、缺氧、心动过缓、尿潴留和低血压发生率相近(χ(2)＝0.310，P>0.05)。镇痛镇静组患者高血压、意外拔管、心动过速发生率明显低于对照组(χ(2)＝16.364、5.143、73.309，P<0.05或P<0.01)。 结论： 重症烧伤患者休克期适当应用镇痛镇静药物，临床效果良好，且并发症发生率低。.

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