中长链脂肪酸丙泊酚减轻小儿注射痛的效果观察

Medium-and long-chain triglycerides propofol reduces injection pain during intravenous anesthesia induction in pediatric surgery

目的观察中长链脂肪酸丙泊酚是否能减轻小儿静脉麻醉诱导注射痛。方法对择期儿科手术的160例患儿采用随机数字表法分成S组、L组、L+P组和M组,每组各40例。S组:静脉注射0.9%氯化钠溶液2ml,30s后注射丙泊酚2.5mg/kg(1%丙泊酚18ml+2ml氯化钠溶液);L组:静脉注射利多卡因0.5mg/kg(稀释成2ml),30s后注射丙泊酚2.5mg/kg(1%丙泊酚18ml+2ml氯化钠溶液);L+P组:静脉注射0.9%氯化钠溶液2ml,30s后注射利多卡因混合丙泊酚2.5mg/kg(1%丙泊酚18ml+2%利多卡因2ml);M组:静脉注射0.9%氯化钠溶液2ml,30s后注射中长链脂肪酸丙泊酚2.5mg/kg(1%中长链脂肪酸丙泊酚18ml+2ml氯化钠溶液)。丙泊酚注射期间使用VRS四分法对患儿进行注射痛评分;并记录丙泊酚注射前和注射时心率,观察注射过程和注射后的不良反应,评价各组疼痛发生率及程度。结果 4组患儿注射痛发生率分别是:S组38例(95%),L组32例(80%),L+P组20例(50%),M组19例(47.5%),L组、L+P组、M组注射痛发生率均低于S组38例(均P<0.05),L+P组、M组注射痛发生率低于L组(P<0.05),其余各组间比较差异无统计学意义(P>0.05);各组丙泊酚注射时心率均增快(P<0.05);与S组比较,丙泊酚注射时L+P组、M组心率低于S组(P<0.05),与L组比较,丙泊酚注射时L+P组心率低于L组(P<0.05);其余各组患儿丙泊酚注射时心率比较差异无统计学意义(P>0.05);各组间不良反应的差异无统计学意义(P>0.05)。结论中长链脂肪酸丙泊酚能减轻小儿静脉麻醉诱导注射痛,与利多卡因混合丙泊酚注射效果相当。

Objective To investigate the effect of medium-and long-chain triglycerides propofol （propofol M/LCT） in reducing injection pain during intravenous anesthesia induction in pediatric surgery. Methods One hundred and sixty pediatric patients who were scheduled for elective operation under general anesthesia were randomly divided into four groups （n=40 in each group）： group S, group L, group L＋P and group M. During anesthesia induction patents in group S, L＋P and M were given 2ml normal saline（NS）, group L was given lidocaine 0.5mg/kg in 2mt NS, followed by injection of 2.5mg/kg propofol （groups S and L）, propofol mixed lidocaine（group L＋P） or 2.5mg/kg propofol M/LCT（group M）, respectively. Pain was assessed by the four-point scores of verbal rating scale at the time of propofol injection. The heart rate was recorded before and during injecting, adverse reaction of injection was observed and the incidence and severity of injection pain was evaluated. Results The incidence of injection pain occurred in groups L, L＋P and M were lower than that in group S（80%, 50% and 47.5%, 97%, P〈0.05）, the incidence in groups L＋P and M was lower than that in group L （P〈0.05）. The heart rate during the injection was higher than that before injection in all groups （P〈 0.05）, the heart rate during the injection in groups L＋P and M was lower than that in group S （P〈0.05）, in L＋P was lower than that in group L （P〈0.05）. There was no difference in adverse reaction of injection among all groups （P 〉0.05）. Conclusion Medium-and long-chain triglycerides propofol can reduce the injection pain during intravenous anesthesia induction with propofol in pediatric surgery, and effect is same to the propofol mixed lidocaine.