Study Of The Treatment With Controllable Analgesia On Procedural Pain In Dressing Changes Of The Burn Injured Patient

Objective:1.To observe the effect of controllable analgesia on procedural pain in dressing changes of the burn injured patients, To approach a kind of effective project of clinical analgesia on procedural pain.2. To observe the diversity of stress reaction on procedural pain in dressing changes of the burn injured patients, To approach the effect of stress reaction produced by procedural pain and analgesia.Methods:The object of study was 120 adult patients of burn injure(VAS>5)and 10 healthy volunteers(group E). The 120 adult patients of burn injure were randomly devided into four groups, Every group was 30 patients of burn injure.Group A was a treatment group which was applied with tramadol hydrochloride injection and ondansetron hydrochloride injection, Group B was a treatment group which was applied with fentanyl citrate injection and ondansetron hydrochloride injection, Group C was a treatment group which was applied with tramadol hydrochloride injection,fentanyl citrate injection and ondansetron hydrochloride injection, Group D was a control group which was applied with 0.9% sodium chloride injection. The index of observation and detection:(1) the patients, VAS pain score between pro- and post-dressing changes in the four groups.(2) the diversity of the patients, pulse,breath,blood pressure and saturation of blood oxygen in the four groups.(3) the patients, adverse effect in the four groups.(4) the numers of the patients, blood sugar,insulin,cortisol and CRP in peripheral blood between pro- and post-dressing changes in the four groups,and the numers of the monitoring indexs in the group E,To compare the numers of the monitoring indexs . All the experimental datas were analyzed by SPSS 15.0.Results:1.the diversity of the patients, VAS pain score in the four groups among pro-dressing changes,mid-dressing changes and post- dressing changes: The pain score of A,B, C,D group patients does not change remarkably in the pro-dressing changes (P>0.05). The patients, pain score of A,B,C group was descended significantly than D group at every phase point in the mid-dressing changes and post- dressing changes (P<0.05). The pain score of A,B group patients does not change remarkably at every phase point in the pro-dressing changes,mid-dressing changes and post- dressing changes (P>0.05). The pain score of A and B group step up remarkably than C group at every phase point in the mid-dressing changes and post-dressing changes (P<0.05). The pain score of A group step up remarkably at every phase point in the mid-dressing changes and in the 10thmin,30thmin of post-dressing changes than in the pro-dressing changes (P<0.05), the same as B group (P<0.05). The pain score of C group has not significantly differences in the pro-dressing changes,at every phase point of mid-dressing changes and in the 10thmin,30thmin of post-dressing changes(P>0.05). The pain score of D group step up remarkably at every phase point in the mid-dressing changes and post-dressing changes than in the pro-dressing changes(P<0.05). The pain score of C group is the lowest in the mid-dressing changes,Yet the pain score of D group is the highest in the mid-dressing changes.2. the diversity of the patients, pulse,breath,blood pressure and saturation of blood oxygen in the four groups:The patients, above-mentioned index of observation in the four groups has not significantly differences among pro-dressing changes,mid-dressing changes and post- dressing changes.3.the adverse effect of burn patients in the course of analgesia intervention: the patients, adverse effect in the four groups has low incidence rate(A group has 4 cases, B group has 5 cases),All the patients have not critical adverse effect.4. the diversity of the patients, blood sugar,insulin,cortisol and CRP in peripheral blood between pro- and post-dressing changes in the four groups and the diversity of the patients, in the E group: Comparison with E group, the numers of the patients, above-mentioned index of observation in the A,B,C,D four groups step up remarkably(P < 0.05). The numers of the patients, above-mentioned index of observation do not change remarkably in the pro-dressing changes in the A,B,C,D four groups(P>0.05). The numers of the patients, above-mentioned index of observation in the A,B,C three groups are lower than the patients, of D group in the post-dressing changes(P<0.05). The numers of the patients, above-mentioned index of observation do not change remarkably between pro- and post-dressing changes in the A,B,C three groups(P>0.05). The numers of the patients, above-mentioned index of observation step up remarkably in the post-dressing changes than in the pro-dressing changes in the D group(P<0.05).Conclusions:1.To aim directly at procedural pain produced by dressing changes in the burn injured patient, The therapeutic regimen of balanced analgesia with tramadol hydrochloride injection and fentanyl citrate injection is certified a kind of safe, effective and satisfactory scheme of clinical analgesia.2.The burn injured patients are higher stress reaction than health adult.3.Procedural pain produced by dressing changes in the burn injured patients can step up the index of stress reaction of the burn injured patients, To perform effective analgesia,it can degrade or avoid the degree of stress reaction in the burn injured patients.