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題名 | Patient-Controlled Analgesia (PCA) with Fentanyl for Dressing Changes in Burn Patients=使用患者自控式"吩坦尼(Fentanyl)" 對於燙傷病人換藥時的疼痛控制 |
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作者 | 鄭清榮; 董光義; 黃俊仁; 賴曉芬; 歐聖運; | 書刊名 | 中華民國重建整形外科醫學會雜誌 |
卷期 | 6:1 1997.03[民86.03] |
頁次 | 頁18-24 |
分類號 | 416.141 |
關鍵詞 | 患者自控式吩坦尼; 燙傷病人; 換藥; 疼痛控制; Patient-controlled analgesia; Fentanyl; Burn; |
語文 | 英文(English) |
中文摘要 | 為了評估幾種不同患者自控式止痛藥“吩坦尼”的處方,於燙傷病人換藥時疼痛控制的效果。我們在20個燙傷病人上施行的60次換藥治療過程,隨機分為三組。第一組:開始時給予生理食鹽水,患者自控式止痛的設定為每次劑量fentanyl 1/kg,鎖定時間30分鐘。第二組:開始時fentanyl 2/kg,患者自控式止痛的設定為每次劑量fentanyl 1/kg,鎖定時間30分鐘。第三組:開始時fentanyl 2/kg,患者自控式止痛的設定為每次劑量fentanyl 1/kg,鎖定時間5分鐘。外科醫師不知道患者為那一組,如果覺得患者需要時可每次給予fentanyl 1/kg救援劑量。其中記錄疼痛目視尺度、fentanyl需求劑量、失敗劑量、滿意程度、救援劑量。記錄時間自換藥前至換藥結束後四小時。 研究結果為換藥中疼痛目視尺度分別為第一組59 ± 2.13、第二組4.88 ± 2.13、第三組3.12 ± 1.98。第三組疼痛目視尺度最低(p < 0.05)。且換藥時第三組的滿意程度最高( p< 0.05)。換藥時fentanyl的需求劑量以第三組3.90 ± 1.37/kg為最高(p < 0.05),第二組2.55 ± 0.76/kg次之,第一組1.95 ± 1.00/kg最低。且第三組不需要任何救援劑量。但是從換藥結束後至其後四小時,這三組則無任何有意義的差別。此研究中沒有發生任何不良的副作用。病患需求的fentanyl劑量有很大的個別差異存在。 由以上的研究結果可知,患者自控式止痛藥“吩坦尼”的處方在換藥時以第三組,即開始時fentanyl 2/kg,患者自控式止痛的設定為每次劑量fentanyl 1/kg,鎖定時間5分鐘,為最有效且安全。至於在換藥後的四小時,這三組處方則無任何差別。 |
英文摘要 | To evaluate different regimens of intravenous PCA fentanyl for dressing change-related pain in burn patients 60 dressing changes among 20 burn patients were studied. They were randomly separated into three groups. Gr.Ⅰ: initial placebo dose, PCA setting with bolus dose, fentanyl 1 /kg; lock-out time 30 min. Gr.Ⅱ: initial fentanyl dose 2 /kg, PCA setting with bolus dose, fentanyl 1 /kg; lock-out time 30 min. Gr.Ⅲ: initial fentanyl 2/kg, PCA setting with bolus dose,fentany 1 /kg;lock-out time 5 min. Surgeons performing the procedures and the patients were blind to the regimen being used. Surgeons could give rescue doses of fentanyl 1 /kg/per dose freely. We recorded the fentanyl requirement, Visual Analogue Pain Score, Fail trial, and Satisfaction Score before the procedue, during the procedure, and until 4 hours after the end of procedure. The results showed that the Visual Analogue Pain Score during procedure (VAS-P) in Gr.Ⅲ was lowest (p < 0.05) (Gr.Ⅰ: 5.9 ± 2.13, Gr.Ⅱ: 4.88 ± 2.13, Gr. Ⅲ:3.12 ± 1.98). The satisfaction of pain relief during procedure was best in Gr.Ⅲ (p < 0.05) (Gr.Ⅰ: 2.8 ± 0.89, Gr.Ⅱ: 3.1 ± 1.12, Gr Ⅲ:3.7 ± 0.98). There were no rescue doses given in Gr.Ⅲ: The total fentanyl requirement during the procedure was the highest in Gr.Ⅲ (p < 0.05) (Gr.Ⅰ: 1.95 ± 1.00/kg, Gr.Ⅱ: 2.55 ± 0.76/kg, Gr.Ⅲ: 3.90 ± 1.37/kg). There were no difference in VAS, satisfaction score, dose requirement, and fail trial during the four hours after the end of procedures. No complications were noted. In conclusion, fentanyl PCA setting with an initial dose of 2/kg,and a PCA bolus does of 1/kg, with a lock-out time of 5 min is an effective and safe way to handle to procedural pain during dressing change in burn patients. After the procedure is completed, all three regimens studied are equally effective in treating burn pain. |
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