闪光对于减轻静脉置管痛的作用：一项前瞻性随机安慰剂对照研究

背景尽管静脉置管时的疼痛经常让人备受困扰，但通常都是在没有任何镇痛措施下进行静脉置管的。临床上曾尝试用一些药物和非药物方法来减轻静脉置管的疼痛，但结果各异。本研究拟评价一次闪光对于减轻静脉置管痛的效果。方法90例拟择期行腹腔镜胆囊切除术的ASAⅠ～Ⅱ级的成年患者（15～60岁），随机分为3组，每组30例，组1为对照组；组2为分散注意力组，即在非优势手的手背静脉进行置管前给患者照相而不使用闪光；组3为闪光组，静脉置管前照相并且使用闪光；在照相后立即使用18G的穿刺针进行静脉置管。结果每组均有2例患者首次静脉穿刺失败，在数据分析中即予以剔除，闪光组疼痛的发生率为50％（28例中14例发生），其他2组为100％（28例全部发生），通过视觉模拟评分评估的疼痛严重程度分散注意力组和闪光组显著低于对照组，而闪光组也显著低于分散注意力组。结论静脉置管前使用闪光是一种减轻疼痛的安全而简单有效的方法。

BACKGROUND： Venous cannulation is often performed without any analgesia, even though pain experienced during this procedure is at times very distressing. Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain. We designed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain. METHODS： Ninety adults （15 - 60 yr）, ASA physical status Ⅰ and Ⅱ, of either sex, undergoing elective laparoscopic cholecystectomy, were included in this prospective and randomized study. Patients were divided into three groups of 30 each. Group Ⅰ （control）; Group Ⅱ （distraction）： photographed without a flash of light; and Group Ⅲ （flash）： photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand. Immediately after the photograph, venous cannulation was performed using an 18-gauge cannula. RESULTS： Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis. The incidence of venous cannulation pain in the flash group was lower, i. e., 50% （14 of 28） when compared to 100% （28 of 28） observed in the other two study groups （P 〈 0.01 ）. Severity of venous cannulation pain as assessed by the Visual Analog Scale scores （between 0 and 100; where 0 = no pain and 100 -- worst imaginable pain） presented as median （interquartile range） were reduced in the flash [ 10 （20）] and distraction [20 （10）] groups compared with the control group [40 （20）] （P 〈 0.01 ）. The severity of venous cannulation pain was also reduced in the flash group compared with the distraction group （P 〈 0. 01 ）. CONCLUSION： We conclude that a flash of light before venous cannulation is a safe, effective, and easy-to-use method for minimizing venous cannulation pain.