芬太尼和舒芬太尼压脉带法预处理用于预防异丙酚注射痛的对比研究

Comparative Study of Fentanil vs Sufentanil Pretreatment by Using Tourniquet for Preventing Propofol Injection Pain

[目的]对比研究芬太尼和舒芬太尼预处理预防异丙酚静脉注射痛（PIP）的临床疗效.[方法]200例ASAⅠ~Ⅱ级接受全麻的择期手术患者,被随机分成四组,每组50例,各组患者注射异丙酚前在前臂结扎一压脉带人为阻断血流,分别予以不同试验药物.F组：芬太尼150 μg;S组：舒芬太尼15 μg;L组：利多卡因40 mg;P组：生理盐水3 mL.注射完毕1 min后松开止血带,再注射1%异丙酚2 mg/kg,注射速度为0.5 mL/s.比较四组PIP情况、麻醉前（T0）、预注药后（T1）和注异丙酚后（T2）的血流动力学指标、呼吸参数及预注试验药物的不良反应.[结果]F组、S组及L组的PIP发生率分别为50%、36%、22%,均显著低于P组80%,其差异有统计学意义（P〈0.01）.四组T1时的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）与T0时比较差异无统计学意义（P〉0.05）.四组T2时MAP较T0、T1显著降低（P〈0.01）;HR较T0、T1稍有降低,但差异无统计学意义（P〉0.05）;SpO2较T0、T1均显著降低,其差异有统计学意义（P〈0.05）.四组副反应咳嗽和皮肤瘙痒发生率比较无显著性差异（P〉0.05）.[结论]芬太尼、舒芬太尼预处理均能显著降低PIP的发生率和严重程度;舒芬太尼在预防PIP方面,其外周镇痛作用优于芬太尼.

[Objective]To compare the clinical efficacy of fentanil vs sufentanil pretreatment for preventing propofol injection pain（PIP）. [Methods] Totally 200 ASA Ⅰ-Ⅱ patients undergoing elective surgery under gener-al anesthesia were randomly assigned into 4 groups with 50 patients in each. The venous drainage of patients in each group was occluded manually by a tourniquet on the forearm, and then different drugs were respectively given to the patients before the injection of propofol. Group F was given fentanil 150μg. Group S was given sufentanil 15μg. Group L was given lidocine 40rag. Group P was given normal saline 3mL. One minute after the injection, the tour-niquet was released and then 1% propofol 2mg/kg with the rate of 0.5ml/s were injected again. PIP, hemodynamic indexes, respiratory parameters before anesthesia（T0 ）, after pre-injection of drugs（T1 ） and after injection of propo-fol（T2 ）, and the side effects of pre-injection drugs were compared among 4 groups. [Results]The incidence of PIP in group F, group S and group L were 50%, 36% and 22% respectively, which were significantly lower than those in group P, and there were significant differences（ P〈0.01）. There was no significant difference in mean arterial pressure（MAP）, heart rate（HR） and SpO2 of patients in 4 groups between T1 and To （ P〉0.05）. Compared with To and T1, MAP at T2 was significantly reduced（P〈0.01）, and HR at T2 was slightly reduced, but there was no significant difference（ P〉0.05）. Compared with To and T1 , SpO2 at T2 was significantly decreased, and there was significant difference（ P〉0.05）. There was no significant difference in the incidence of cough and skin itchy among 4 groups（ P 〉0.05）. [Conclusion]Fentanil or sufentanil pretreatment can markedly reduce the incidence and severi-ty of PIP. The peripheral analgesia effect of sufentanil for preventing PIP is superior to fentanil.