外用药物镇痛模式在剖宫产患者颈内静脉穿刺中的应用探讨

Effect of topical drugs analgesic model on internal jugular vein puncture in cesarean section patients

目的探讨复方利多卡因乳膏减轻行颈内静脉穿刺所产生疼痛的效果,提高患者满意度。方法采用方便抽样法选取2019年12月至2020年12月北京妇产医院60例行颈内静脉穿刺的重症剖宫产患者,随机分为试验组与对照组,每组30例。对照组采用常规的利多卡因注射液在颈内静脉穿刺点周围进行局部浸润麻醉,试验组则在颈内静脉穿刺前1h,以颈内静脉穿刺点为中心,均匀涂抹复方利多卡因乳膏进行表面涂抹麻醉,1h后再进行颈内静脉穿刺。比较两组患者在穿刺时的视觉模拟评分法(visual analogue scale,VAS)疼痛评分、心率(heart rate,HR)和血压(blood pressure,BP)变化及患者满意度。结果试验组与对照组一般资料比较差异无统计学意义(P>0.05),两组人群具有可比性。试验组患者穿刺过程中HR为(80.200±5.156)次/min,明显低于对照组患者穿刺过程中HR(93.630±9.246)次/min,差异有统计学意义(P<0.001)。试验组患者穿刺后HR为(77.770±6.621)次/min,低于对照组患者穿刺后HR(85.800±7.453)次/min,差异有统计学意义(P<0.001)。试验组患者穿刺中收缩压(systolic blood pressure,SBP)与舒张压(diastolic blood pressure,DBP)分别为(122.630±6.764)mmHg和(73.630±6.272)mmHg,低于对照组患者穿刺中SBP与DBP(143.570±14.550)mmHg和(89.870±9.644)mmHg,差异有统计学意义(P<0.001)。试验组患者穿刺后SBP与DBP分别为(120.670±5.797)mmHg和(71.670±8.715)mmHg,低于对照组患者穿刺后SBP与DBP(135.530±14.188)mmHg和(82.490±9.126)mmHg,差异有统计学意义(P<0.001)。试验组患者疼痛评分为[1(1)]分,明显低于对照组患者疼痛评分[9(1)]分,差异有统计学意义(P<0.05)。试验组穿刺满意度总分为[15(0)]分,明显高于对照组[12(0)]分,差异有统计学意义(P<0.05)。结论穿刺前1h运用复方利多卡因乳膏涂表麻醉的方式可以有效缓解患者在行颈内静脉穿刺时的疼痛,避免常规局部浸润麻醉药物给患者带来的疼痛感,提高患者满意度。

Objective To analyze the effects of pain alleviation and satisfaction by using compound lidocaine gel on internal jugular vein puncture in cesarean section patients.Method A total of 60 cesarean section patients from Beijing Obstetrics and Gynecology Hospital who underwent deep venipuncture were randomly divided into experimental group and control group with 30 cases in each group from December of 2019 to December of 2020.The patients in control group were anesthetized by local injection of lidocaine around the deep vein puncture site before anesthesia,while the patients in experimental group were applied with lidocaine gel for surface anesthesia 1 hour before the deep vein puncture.Visual analogue scale(VAS)pain score,heart rate(HR),blood pressure(BP)and satisfaction at the time of puncture were compared between the two groups.Result Baseline characteristics between the experimental group and the control group were not statistical different(P>0.05).During puncture,HR[(80.200±5.156)times/min vs.(93.630±9.246)times/min,P<0.001],systolic blood pressure(SBP)[(122.630±6.764)mmHg vs.(143.570±14.550)mmHg,P<0.001]and diastolic blood pressure(DBP)[(73.630±6.272)mmHg vs.(89.870±9.644)mmHg,P<0.001]in the experimental group were significantly lower than those in the control group.After puncture,HR[(77.770±6.621)times/min vs.(85.800±7.453)times/min,P<0.001],SBP[(120.67±5.797)mmHg vs.(135.530±14.188)mmHg,P<0.001]and DBP[(71.670±8.715)mmHg vs.(82.490±9.126)mmHg,P<0.001]in the experimental group were significantly lower than those of the control group.The pain score in the experimental group was[1(1)],which was significantly lower than that of the control group[9(1)],with P<0.05.The total satisfaction score in the experimental group was[15(0)]points,which was significantly higher than that in the control group[12(0)]points,with P<0.05.Conclusion Compound lidocaine gel for surface anesthesia can effectively relieve during deep vein puncture and improve patients􀆳satisfaction in cesarean section women.