混合0.3%利多卡因对丙泊酚注射痛的影响

Effect of the mixture of 0.3% lidocaine and propofol on propofol injection pain

目的:探讨混合利多卡因抑制丙泊酚注射痛的最佳浓度,并对其有效性及安全性进行评价。方法:收集无痛人工流产手术病人(ASAⅠ～Ⅱ级)809例,采用阶梯式递增、递减模式,滴定混合利多卡因的最佳浓度。病人静注舒芬太尼后随机分为3组,空白组(A组)静注1%丙泊酚;对照组(B组)预注利多卡因40 mg后,静注1%丙泊酚;试验组(C组)注射0.3%利多卡因及0.83%丙泊酚的混合液。注射期间对注射痛评分,同时观察记录注药前后血压、心率(HR)及氧饱和度(SpO_2)、清醒时间及呼吸、循环抑制、恶心呕吐等不良反应,术后调查病人满意度。结果:3组病人用药前舒张压差异无统计学意义(P>0.05),B组、C组收缩压均高于A组(P<0.01),用药后1 min、3 min 3组收缩压、舒张压均较术前明显降低(P<0.01),组间比较差异无统计学意义(P>0.05);3组病人HR用药前无差别,用药后1 min均下降(P<0.05～P<0.01),用药后3 min A组HR仍低于用药前(P<0.05),B组、C组HR均低于用药前,但差异无统计学意义(P>0.05);用药后C组HR高于B组(P<0.05);SpO_2用药后均明显降低(P<0.01),但组间差异无统计学意义(P>0.05),3组用药后3 min SpO_2较用药后1min明显升高(P<0.01),且B组、C组明显高于A组(P<0.01)。3组疼痛发生率比较:C组<B组<A组(P<0.05),病人满意率比较:C组>B组>A组(P<0.05)。3组病人低SpO_2、低血压、低心率、恶心呕吐及体动等不良反应发生率差异均无统计学意义(P>0.05)。结论:混合0.3%利多卡因的丙泊酚可以安全、有效消除注射痛。

Objective:To investigate the optimal concentration of lidocaine in inhibiting the propofol injection pain,and evaluate its efficacy and safety.Methods:The optimal concentration of lidocaine in painless artifical abortion patients(ASAⅠtoⅡ)was detected using step by step increasing or decreasing mode.The patients injected with sufentanil were randomly divided into the blank group(group A injected with 1%propofol),control group(group B injected with 1%propofol after 40 mg of lidocain preinjection)and experimental group(group C injected with the mixture of 0.3%lidocaine and 0.83%propofol).The pain scores in three groups were evaluated during injection period.The blood pressure before and after injection,heart rate(HR)and SpO 2,waking time,respiratory or circulatory inhibition,nausea or vomiting and satisfaction degree in three groups were analyzed.Results:Before medication,the differences of diastolic pressure among three groups were not statistically significant(P>0.05),and the levels of systolic pressure in group B and group C were higher than that in group C(P<0.01).After 1 min and 3 min of medication,the levels of diastolic pressure and systolic pressure in three groups significantly decreased compared with before medication(P<0.01),and the differences of those among three groups were not statistically significant(P>0.05).There was no difference in HR among three groups before medication,the HR in three groups after 1 min of medication significantly decreased(P<0.05 to P<0.01).After 3 min of medication,the HR in group A was lower than before medication(P<0.05).After 3 min of medication,the HR in group B and group C were lower than before medication,and the difference of which was not statistically significant(P>0.05).After medication,the HR in group C was significantly higher than that in group B(P<0.05).After medication,the SpO 2 levels in three groups significantly decreased(P<0.01),but the differences of which among three groups were not statistically significant(P>0.05).After 3 min of medication,the SpO 2 levels in three groups significantly increased compared with after 1 min of medication(P<0.01),and which in group B and group C were higher than that in group A(P<0.01).The incidence rates of severe pain and satisfaction degree in group C,group B and group A gradually increased in turn,respectively(P<0.05).The differences of the incidence rates of low SpO 2,blood pressure and heart rate,nausea,vomiting and movement among three groups were not statistically significant(P>0.05).Conclusions:The mixture of 0.3%lidocaine and 0.83%propofol can safely and effectively eliminate the injection pain of propofol.