瑞芬太尼与利多卡因用于预防小儿丙泊酚注射痛的对比研究

Comparison of remifentanil pretreatment or lidocain in prevention of propofol-induced injection pain in children

目的比较预先注射瑞芬太尼和混合注射利多卡因预防丙泊酚注射痛的效果。方法 150例拟行全身麻醉的手术患儿,ASAI～Ⅱ级,年龄3～10岁,随机分为利多卡因、瑞芬太尼Ⅰ组(R^(0.25))和瑞芬太尼Ⅱ组(R^(0.5)),每组50例。利多卡因组患儿注射丙泊酚(AstraZeneca)2.5 mg/kg,混合利多卡因浓度为丙泊酚100 mg混合利多卡因10 mg,瑞芬太尼组Ⅰ(R^(0.25))缓慢静注瑞芬太尼0.25μg/kg,瑞芬太尼组Ⅱ(R^(0.5))缓慢静注瑞芬太尼0.5μg/kg。60 s后静脉注射丙泊酚2.5 mg/kg。用Cameron的疼痛评分方法进行注射疼痛的评分。结果利多卡因组、瑞芬太尼组Ⅰ、瑞芬太尼组Ⅱ分别有1例(2%)、5例(10%)、2例(4%)患儿重度疼痛。利多卡因组和瑞芬太尼组Ⅱ(R^(0.5))之间的疼痛评分无显著性差异。瑞芬太尼组Ⅰ(R^(0.25))的疼痛程度比利多卡因组和瑞芬太尼组Ⅱ(R^(0.5))高,差异有统计学意义(P<0.05)。结论预注0.5μg/kg的瑞芬太尼与丙泊酚混合利多卡因注射对预防小儿丙泊酚注射痛的效果较好,两者疗效相当,而预注0.25μg/kg瑞芬太尼的效果较差。

Objective To compare the efficacy of pretreatment with remifentanil or lidocaine mixed with propofol on injection pain of propofol. Methods 150 patients undergoing elective general anesthesia （ aged 3 - 10, ASA Ⅰ-Ⅱ） were randomly allocated into 3 groups, with 50 patients in each group. In the lidocaine group, lidocaine 10 mg was mixed with propofol 100 mg prior to administered mixed propofol 2.5 mg/kg; in remifentanil group ] （ R^0.25 ） , remifentanil 0.25 μg/kg was administed 60s prior to propofol; In remifentanil group Ⅱ （ R^0.5 ） , remifentanil 0. 5 μg/kg was administed prior to propofol; injection pain was evaluated by Cameron scores. Results There were 1 patient（2% ） , 5 patients（10% ） and 2 patients （4%）with severe pain in lidoeaine group, remifentanil group Ⅰ or remifentanil group Ⅱ , respectively. There was no difference in pain score between lidocaine group and remifentanil group Ⅱ. Pain scores in remifentanil group Ⅰ were higher than in the other two groups （ P 〈 0. 05 ）. Conclusion Pretreatment of remifentanil 0. 5 μg/kg was as effective as lidoeain - propofol mixture.