预先静脉注射右美托咪定与利多卡因对罗库溴铵注射痛的影响

Effects of pretreatment with different doses of dexmedetomidine and lidocaine on rocuronium injection associated pain

目的研究预先静脉注射右美托咪定（dexmedetomidine，Dex）和利多卡因对罗库溴铵注射痛的影响。方法选择行经口插管全麻的择期手术患者160例，美国麻醉医师协会（ASA）分级I～Ⅱ级，按照随机数字表法分为4组：对照组（C组）、Dex低剂量组（D1组）、Dex高剂量组（D2组）和利多卡因组（L组），每组40例。D1组和D2组患者分别预先静脉泵注Dex0．2、0．4μg／kg；L组患者预先静脉泵注利多卡因0．5mg／kg；C组则给予等容生理盐水（10m1），均在10min注射完毕。然后各组患者静脉注射罗库溴铵10mg（1m1），2S内推注完。立即评测患者疼痛评分、镇静评分，记录低血压、心动过缓及输注并发症。结果4组患者一般情况差异无统计学意义；C组注射痛发生率（82．5％）明显较D1组（60．0％）、D2组（40．0％）和L组（32．5％）高（P〈0．05）；D1组注射痛发生率明显高于D2组和L组（P〈0．05）；而D2组和L组注射痛发生率及疼痛程度相似；D2组镇静评分明显高于其他3组（P〈0．05）；各组低血压、心动过缓及输注并发症差异无统计学意义。结论预先静脉注射Dex0．2、0．4μg／kg及利多卡因0．5μg／kg均能明显减少罗库溴铵引起注射痛的发生率，且以Dex0．4μg／kg及利多卡因0．5mg／kg效果最佳。

Objective To compare the efficacy of pretreatment with dexmedetomidine （Dex） and lidocaine to prevent rocuronium injection pain. Methods One hundred and sixty patients （ASA I -II ） scheduled for elective surgery were randomly divided into 4 groups（n=40）： control group（Group C）, Dex 0.2 μg/kg group（Group D1 ）, Dex 0.4 μg/kg group（Group D2） and lidoeaine 0.5 mg/kg group （Group L）. Patients in Group D1, Group D2 and Group L received intravenous Dex 0.2, 0.4 μg/kg and lidoeaine 0.5 mg/kg respectively, while patients in Group C received intravenous normal saline with the same volume（ 10 ml） within 10 rain. Then all patients are intravenously injected rocuronium 10 mg （1 ml） within 2 s. The pain score, sedation and side effects were recorded. Results Demographic parameters were similar among groups. Comparing to Group C, the incidence of pain in Group C（82.5% ） was significantly higher than that in Group D1 （60.0%）, Group D2（40.0% ） and Group L（32.5% ）（P〈0.05 ）. The frequency and intensity of rocuronium injection pain were statistically similar between Group D2 and Group L. The frequency of pain in the Group D2 and Group L was significantly less than the Group D1 （P〈0.05）. Sendation score in the Group D2 was significantly higher than the other three groups （P〈0.05）. Hypotension, bradycardia and side effects of injection were similar among groups. Conclusions Pretreatment with Dex and lidocaine was effective in reducing the frequency and severity of pain with rocuronium injection but pretreatment with Dex 0.4 μg/kg and lidocaine 0.5 mg/kg proved to be the most effective treatments.