阿芬太尼和瑞芬太尼减轻丙泊酚注射痛的效应观察

Efficacy of alfentanil and remifentanil in minimizing propofol injection pain

目的比较阿芬太尼、瑞芬太尼预处理对丙泊酚注射痛的影响。方法将175例需在全麻下进行妇科手术的成年女性患者随机分为四组:阿芬太尼(1 mg/2 mL)组(AL组,n=43)、瑞芬太尼(0.01 mg/2 mL)1组(REM1组,n=43)、瑞芬太尼(0.02 mg/2 mL)2组(REM2组,n=45)及生理盐水(2 mL)对照组(n=44),30 s后注射丙泊酚。根据患者的主观感觉进行疼痛模拟评分(VAS),并记录注药期间出现的所有不良反应。结果REM2组和对照组各1例患者因静脉置管困难而排除。AL组、REM1组、REM2组三组患者出现的注射痛严重程度均明显轻于对照组(P<0.05),AL组在缓解丙泊酚注射痛上比REM1组和REM2组更有效(P<0.05),而REM2组在缓解丙泊酚注射痛上比REM1组有效(P<0.05)。用药组的丙泊酚注射痛发生率均明显低于对照组(P<0.01)。AL组中有1例患者在注药后出现了恶心;REM2组中有1例患者在注药完成后出现恶心,1例患者在注药过程中出现会阴搔痒。结论阿芬太尼与瑞芬太尼能有效缓解疼痛的发生。瑞芬太尼在预防丙泊酚注射痛时是有效的,且剂量应≥0.02 mg。

Objective To compare the efficacy of alfentanil and remifentanil in minimizing the propofol injection pain. Methods A total of 175 adult female patients undergoing gynecological procedures with general anesthesia were randomly divided into four groups. Patients received alfentauil ling （2 mL, AL group, n =43） , remifentanil 0.01 mg （2 mL, REM1 group, n=43）, remifentanil 0.02 mg （2 mL, REM2 group, n =45） or normal saline （2 mL, control group, n=44） 30 seconds prior to propofol administration. Visual analogue scale （VAS） was employed to evaluate the subjective feelings of pain due to propofol injection, and adverse effects were recorded. Results One patient in REM2 group and one patient in control group were excluded due to difficulty in venous catheterization. The injection pain in AL group, REM1 group and REM2 group was significantly less severe than that in control group （P 〈0.05）, AL group was less severe than REM1 group and REM2 group （P 〈0.05）, and REM2 group was less severe than REM1 group （P 〈0.05）. The prevalences of injection pain in AL group, REM1 group and REM2 group were significantly less than that in control group （P 〈0.01）. One patient in AL group and one patinet in REM2 group experienced nausea after injecton, and one patient in REM2 group suffered from perineal itching during injection. Conclusion Alfentanil and remifentanil are effective in relieving propofol injection pain, and the minimal dose for remifentanil should be 0.02 mg.