Effect Of Subanesthetic Dose Of Ketamine Combined With Fentanyl On Pain Score And Anxiety In Patients With Large Area Burn Requiring Bedside Dressing

Objective:To study the effect of subanesthetic dose of ketamine combined with fentanyl on pain scores and anxiety in patients with large-area burns requiring bedside dressing.Methods:A total of 138 times patients with deep II and III degree burns from January 2016 to January 2018 in our hospital were randomly divided into four groups according to random number method.Group A:Flurbiprofen+ketamine+dexmedetomidine,Group B:Flurbiprofen+fentanyl+dexmedetomidine,group C:Flurbiprofen+fentanyl+ketamine+dexmedetomidine,group D:Flurbiprofen(refuses to painless dressing),34 patients in each group of group A and B,and 35patients in group C and D.The four groups were balanced in terms of age,gender,body weight,and total surface area of burn(P>0.05).By comparing the patients 15 minutes before dressing change,when changing dressing,2h,4h after dressing change VAS score and Ramsay sedation score,15min before dressing change,when changing dressing,10min after dressing change,30min after dressing change,2 hours after dressing change the changes of HR,RR,MAP and Sp02 indexes in patients after drug administration,the occurrence of nausea vomiting,itching,Respiratory depression and dizziness within 48 hours after dressing change,the patient’s mental state was assessed by the hospital anxiety and depression scale 24 hours before dressing change and 24 hours after dressing change.Results:1.Compared with different analgesic regimens,there were no significant differences between the four groups of VAS scores and Ramsay scores 15 min before the dressing change(P>0.05).VAS score and Ramsay score of groups A,B and C at dressing change time,2 hours after dressing change,4 hours after dressing change were significantly different from those of group D(P<0.05);VAS score and Ramsay score between groups A and B at each time point after dressing change had no obvious difference(P>0.05).The VAS score of group C was lower than that of group A and B,and Ramsay score was higher than that of group A and B at each time point after dressing change.(P<0.05).In group C there was no significant difference in VAS score between 15 minutes before dressing change and each time point after dressing change(P>0.05),and Ramsay score was higher at each time point after dressing change than that before dressing change 15 minutes.2.There were no significant differences in vital signs(HR,RR,MAP,Sp02)between the 4 groups before the dressing change、10 min after the dressing change,30 min after the dressing change,and 2h after the dressing change.(P>0.05).3.There was no significant difference in the incidence of adverse reactions within 48 hours after dressing change in 4 groups(P>0.05).4.There was a significant difference between the 24h after dressing change and 24h before dressing change(P<0.05).The scores of group A,B,C were significantly better than D(P<0.05).The improvement of anxiety in group C was significantly better than that in group A and B(P<0.05).Compared with group B,The improvement of anxiety was more obvious in group A(P<0.05).Conclusion:The subanesthetic dose of ketamine combined with fentanyl has much effect on the analgesic effect,less effect on vital signs,and more obvious effects on anxiety in patients with large-area burns requiring bedside dressing.It does not increase the incidence of adverse reactions and is worthy of further clinical research.