预注不同剂量舒芬太尼减轻丙泊酚乳剂注射痛的临床观察

Preventive effect of sufentanil pretreatment on propofol injection pain

目的观察预先使用不同剂量的舒芬太尼对丙泊酚乳剂注射痛的影响。方法200例ASAⅠ-Ⅱ级接受全麻的择期手术患者被随机分成4组:S10组、S15组、L组和P组,每组50例。各组患者于注射丙泊酚前均在前臂结扎一可充气止血带(压力为70mmHg)人为阻断血流,分别被给予以下试验药物:舒芬太尼10μg(S10组)、舒芬太尼15μg(S15组)、利多卡因40mg(L组)和生理盐水3ml(P组),注射完毕1min后松开止血带,均再注射1%丙泊酚2mg/kg,依Ambesh四分法评价并记录丙泊酚注射疼痛发生率和程度,记录病人麻醉前(T0)、预注药后(T1)和注丙泊酚后(T2)三个时点的血流动力学指标、呼吸参数、预注试验药物的副作用。结果S10组、S15组及L组的丙泊酚注射痛发生率(分别为44%,36%,22%)和严重程度明显低于P组(80%,P<0.01),但S10组、S15组镇痛效果不如L组(P<0.01)。S15组减轻丙泊酚注射痛的有效性要优于S10组(P<0.05)。结论预注舒芬太尼能显著降低丙泊酚注射痛的发生率和严重程度,在不宜使用利多卡因时具有良好的临床运用前景。

Objective To evaluate the preventive effect of various dosages of sufentanil pretreatment on propofol injection pain. Methods Two hundred ASA Ⅰ - Ⅱ patients, undergoing general anesthesia for elective surgery, were randomly assigned into four groups：S10 group, S15 group, L group and P group. The venous drainage was occluded manually by a pneumatic tourniquet on the forearm with inflation pressure 70 mmHg,and then the patients were given sufentanil 10 μg in S10 group,sufentanil 15 μg in S15 group,lidocine 40 mg in L group and 3 ml normal saline in P group. After injection for 1 min, the tourniquet was released, and all the patients were injected with 1% propofol 2 mg/kg at the rate of 0.5 ml/s. The incidence and severity of propofol injection pain were evaluated and recorded using the four-point scale of Ambesh. Moreover, the following items were also recorded and observed such as the hemodynamic data, the parameters of respiration, and the side effects of study drugs before anesthesia（ T0）, after injecting study drugs （T1 ）and after injecting propofol（T2 ） ,respectively. Results The incidence and severity of pain induced by propofol injection in S10 and S15 groups were all significantly lower than those in P group（ P 〈 0.01 ）. Lidocaine had better preventive effect than sufentanil on propofol injection pain （ P 〈 0.01 ）. The efficacy on reducing propofol injection pain in S15 group was better than in S10 group （ P 〈 0.05 ）. Conclusion Sufentanil pretreatment can reduce the incidence and severity of propofol injection pain, and may be recommended for patients when li- doeaine is not suitable for being used.