静脉预注硫酸镁抑制丙泊酚注射痛的临床研究

Clinical research of intravenous pretreatment with magnesium sulfate for inhibiting propofol-induced pain

目的:评价静脉预注硫酸镁对丙泊酚注射痛的防治作用。方法:160例ASAⅠ～Ⅱ拟行择期外科、妇科手术患者,随机分为M、L、K及S组,每组40例。右侧手背静脉置入20 G套管针作为试验用药及全麻诱导通路,距腕部5 cm处扎橡皮静脉止血带。M组、L组、K组、S组分别静脉注射20 mg/kg硫酸镁、0.5 mg/kg利多卡因、0.3 mg/kg氯胺酮及生理盐水5 ml。注药1 min后松开止血带,以0.5 ml/s静脉注射1%丙泊酚2 mg/kg。以口述描绘评分法(VRS)评估各组患者丙泊酚注射痛的发生率及其严重程度。记录给药前、松开止血带后、麻醉诱导完成后、气管插管即刻各组患者的MAP、HR。结果:M组、L组、K组及S组丙泊酚注射痛发生率分别为25%、55%、50%和95%,M组、L组、K组注射痛发生率均明显低于S组(P<0.01);M组与L组丙泊酚注射痛发生率差异有统计学意义(P<0.05);M组与K组、L组与K组丙泊酚注射痛发生率差异均无统计学意义(P>0.05)。M组、L组、K组与S组比较,丙泊酚注射痛的严重程度均明显下降(P<0.01);而M组、L组与K组间丙泊酚注射痛的严重程度差异均无统计学意义(P>0.05)。各组患者的MAP、HR基本稳定。结论:结合止血带技术,静脉预注20 mg/kg硫酸镁、0.5 mg/kg利多卡因、0.3 mg/kg氯胺酮均能有效抑制丙泊酚注射痛的发生及其严重程度,且对血压、心率影响轻微,其中以硫酸镁效果最佳。

Objective：To assess the efficacy of intravenous pretreatment with magnesium sulfate on propofol injection-induced pain.Methods：One hundred and sixty ASA Ⅰ-Ⅱ patients undergoing general anaesthesia were rando mly allocated into four groups：M,L,K and S group（forty in each group）.A 20-gauge catheter was inserted into vein on the back of right hand for drug injection and anaesthesia,and with a rubber venous tourniquet 5 cm near wrist.In M,L,K and S group,patients were pretreated with i.v 20 mg/kg of magnesium sulfate（M）,0.5 mg/kg of lidocaine（L）,0.3 mg/kg of ketamine（K）,and 5 ml normal saline（S）,respectively.The occlusion was released after 1 min,2 mg/kg of propofol was injected into vein by the infusion at 0.5 ml/s.The incidence and intensity of pain was assessed by verbal rating scales（VRS）.Patients′ MAP and HR were recorded at the point of before administration,tourniquet released,after induction of anesthesia and endotracheal intubation.Results：The incidence of pain in M group was 25% compared to 55% for L group,50% for K group and 95% for S group.The incidence and intensity of pain in all groups were significantly lower than in S group（P0.01）.The incidence of pain in M group was significantly lower than in L group（P0.05）,and was similar to K group;K group was similar to L group（P0.05）.The intensity of pain in M group was significantly lower than in L,K and N group（P0.01）,respectively,and there were no statistical differences in M,L and K group（P0.05）.There were no significant differences in MAP and HR between all groups.Conclusions：Combined with tourniquet technique,intravenous pretreatment with magnesium sulfate,lidocaine and ketamine are effective in attenuating propofol-induced pain.However,it has been observed that pretreatment with magnesium sulfate was the most effective.