全麻诱导期不同预给药方式对丙泊酚注射痛的效果比较

The Effect of Pretreatment to Pain on Injection of Propofol during the Induction of General Anesthesia

目的比较全麻诱导期不同预处理方式对丙泊酚注射痛的效果。方法收集择期全麻下行外科手术患者100例,男性57例,女性43例,年龄(34.06±5.92)岁(25～45岁)。ASAⅠ～Ⅱ级,随机数字表法分为4组(n=25),即对照组(C):预注射生理盐水5mL;芬太尼组(F):预注射芬太尼0.004mg/kg;利多卡因1组(L1):预注射利多卡因1mg/kg;利多卡因2组(L2):左肘关节上1寸捆扎止血带,预注射利多卡因1mg/kg,并于静注丙泊酚时松开。所有药物均于静注丙泊酚前30s,按1mL/3s速度静脉推注。当丙泊酚推注量达到5mL(50mg)时,采用VAS评估丙泊酚注射痛情况。记录注射丙泊酚前后平均动脉压(MAP)、心率(HR),率压积(RPP)和心电图,肘静脉抽取静脉血测定血清皮质醇含量。结果各预处理组与C组比较,丙泊酚注射痛发生率显著降低(χ2=8.694,P<0.05),MAP、HR、RPP、注射痛严重程度明显降低(P<0.05),而血清皮质醇含量差别无统计学意义(P>0.05)。F、L1和L2组间比较,注射丙泊酚前后MAP、HR、RPP、血清皮质醇含量、注射痛严重程度差别无统计学意义(P>0.05),注射痛的特点各异。结论应用利多卡因、芬太尼全麻诱导期预处理均可减轻丙泊酚注射痛。

Objective To compare the effect of different pretreat to pain on injection of Propofol during the induction of general anesthesia.Methods One hundred ASA Ⅰ or Ⅱ patients aged（34.06±5.92） years were scheduled for surgery under general anesthesia from March 2010 to March 2011 in our hospital.They were divided into four groups of twenty five each with random number table.Group C,Group F and Group L1 patients were pre-injected with normal saline solution 5 mL,Fentanyl Citrate Injection 0.004 mg/kg and Lidocaine Hydrochloride Injection 1 mg/kg respectively.Group L2 patients were pre-injected Lidocaine Hydrochloride Injection 1 mg/kg after tourniquet upper one inch left elbow joint and then released tourniquet before Propofol injection.All drugs were intravenous injected before 30 seconds Propofol injection at the rate on 1 mL/3 s.The pain on injection was evaluated with the vision analogue scale（VAS） when Propofol was injected 5 mL（50 mg）.The values of mean artery pressure（MAP）,heart rate（HR）,rate pressure product（RPP）,ECG and lever of serum cortisol were recorded before and after propofol injection.Results Compare each pretreatment groups with C group,incidence rate of pain on injection of Propofol was significantly reduced（χ2=8.694,P0.05）.The values of MAP,HR,RPP and the degree of pain were significantly lower than those of group C（P0.05）,but the level of serum cortisol was not significant difference（P0.05）.Compare with each pretreatment groups,the values of MAP,HR,RPP,the degree of pain and the levels of serum cortisol were not significant difference（P0.05）.But the characteristics of pain on injection of Propofol existed significant difference.Conclusion Both Lidocaine and Fentanyl,the pretreatment shall reduce the pain on injection of Propofol during the induction of general anesthesia.