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临床剂量的丙泊酚具有起效快、苏醒快且功能恢复完全、术后恶心呕吐发生率低等优点,成为门诊及日间无痛手术麻醉的主要用药。但其引起的注射局部性疼痛的发生率可达28%~90%[1],其中约有30%的病人不能忍受该疼痛。该疼痛源于酚类直接刺激静脉壁,而利多卡因能减轻支配血管内皮和平滑肌神经的直接刺激[2],可以有效减轻甚至消除注射痛。但有关利多卡因消除注射痛的最佳浓度尚无定论。本文拟探讨混合利多卡因的丙泊酚消除局部注射痛的最佳浓度,并评价其有效性及安全性,以提高病人舒适度及安全度。
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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);SpO2用药后1 min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 SpO2较用药后1 min明显升高(P < 0.01),且B组、C组明显高于A组(P < 0.01)(见表 1)。
分组 n 用药前 用药后1 min 用药后3 min F P MS组内 收缩压/mmHg A组 269 126.5±12.3 103.8±8.6▲▲ 105.5±8.8▲▲ 426.21 < 0.01 100.897 B组 270 132.4±10.5** 104.7±8.5▲▲ 106.4±9.0▲▲■ 740.93 < 0.01 87.833 C组 270 129.8±9.7**## 105.3±8.9▲▲ 106.3±8.5▲▲ 634.18 < 0.01 81.850 F — 19.88 2.04 0.85 — — — P — < 0.01 > 0.05 > 0.05 — — — MS组内 — 118.503 75.142 76.896 — — — 舒张压/mmHg A组 269 76.5±7.4 65.4±8.1▲▲ 65.7±8.3▲▲ 170.52 < 0.01 63.087 B组 270 75.7±7.8 65.9±8.2▲▲ 66.5±8.5▲▲ 121.35 < 0.01 66.777 C组 270 77.2±8.0 66.7±7.7▲▲ 67.3±8.7▲▲ 141.54 < 0.01 66.327 F — 2.54 1.81 2.39 — — — P — > 0.05 > 0.05 > 0.05 — — — MS组内 — 59.873 64.045 72.281 — — — HR/(次/分) A组 269 78.9±12.5 75.7±11.7▲▲ 76.7±10.8▲ 5.28 < 0.01 136.593 B组 270 77.8±13.6 74.9±12.8▲ 75.7±11.4 3.80 < 0.05 159.587 C组 270 80.2±14.2 77.5±13.3#▲ 78.3±11.6# 3.04 < 0.05 171.030 F — 2.15 3.01 3.65 — — — P — > 0.05 < 0.05 < 0.05 — — — MS组内 — 180.981 159.234 127.066 — — — SpO2/% A组 269 97.73±1.24 95.20±4.35▲▲ 96.35±1.38▲▲■■ 57.90 < 0.01 7.455 B组 270 97.68±1.30 95.28±4.38▲▲ 96.80±1.40**▲▲■■ 52.29 < 0.01 7.612 C组 270 97.69±1.35 95.25±4.35▲▲ 96.75±1.45**▲▲■■ 53.69 < 0.01 7.616 F — 0.11 0.02 8.24 — — — P — > 0.05 > 0.05 < 0.01 — — — MS组内 — 1.684 19.010 1.989 — — — q检验:与A组比较**P < 0.01;与B组比较#P < 0.05,##P < 0.01;与用药前比较▲▲P < 0.01;与用药后1 min比较■■P < 0.01 表 1 3组病人用药前后血压、HR及SpO2比较(x±s)
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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)(见表 2)。
分组 n 重度疼痛 中度疼痛 轻度疼痛 无痛 疼痛发生 满意 A组 269 20(7.43) 57(21.19) 75(27.88) 117(43.49) 77(28.62) 225(83.64) B组 270 10(3.70) 15(5.56) 50(18.51) 195(72.22) 25(9.26)* 255(94.44) * C组 270 0(0.00) 4(1.48) 35(12.96) 235(87.03) 4(1.48)*# 268(99.26)*# Hc — 128.32 49.42 P — < 0.01 < 0.01 与A组比较*P < 0.05;与B组比较#P < 0.05 表 2 3组病人丙泊酚注射痛的发生情况及病人满意率比较[n; 百分率(%)]
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3组病人低SpO2、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)(见表 3)。
分组 n 低SpO2 低血压 低心率 恶心呕吐 体动 A组 269 35(13.01) 20(7.43) 17(6.32) 2(0.74) 5(1.90) B组 270 36(13.33) 21(7.78) 17(6.30) 2(0.74) 5(1.85) C组 270 36(13.33) 20(7.47) 18(6.67) 1(0.37) 5(1.85) χ2 — 0.02 0.03 0.04 0.40 0.00 P — > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 表 3 3组病人发生不良反应的比较[n; 百分率(%)]
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
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摘要:
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(SpO2)、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);SpO2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 SpO2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SpO2、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。 Abstract:ObjectiveTo investigate the optimal concentration of lidocaine in inhibiting the propofol injection pain, and evaluate its efficacy and safety. MethodsThe optimal concentration of lidocaine in painless artifical abortion patients(ASA Ⅰ to Ⅱ)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 SpO2, waking time, respiratory or circulatory inhibition, nausea or vomiting and satisfaction degree in three groups were analyzed. ResultsBefore 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 SpO2 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 SpO2 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 SpO2, blood pressure and heart rate, nausea, vomiting and movement among three groups were not statistically significant(P > 0.05). ConclusionsThe mixture of 0.3% lidocaine and 0.83% propofol can safely and effectively eliminate the injection pain of propofol. -
Key words:
- injection pain /
- propofol /
- lidocaine /
- pretreatment
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表 1 3组病人用药前后血压、HR及SpO2比较(x±s)
分组 n 用药前 用药后1 min 用药后3 min F P MS组内 收缩压/mmHg A组 269 126.5±12.3 103.8±8.6▲▲ 105.5±8.8▲▲ 426.21 < 0.01 100.897 B组 270 132.4±10.5** 104.7±8.5▲▲ 106.4±9.0▲▲■ 740.93 < 0.01 87.833 C组 270 129.8±9.7**## 105.3±8.9▲▲ 106.3±8.5▲▲ 634.18 < 0.01 81.850 F — 19.88 2.04 0.85 — — — P — < 0.01 > 0.05 > 0.05 — — — MS组内 — 118.503 75.142 76.896 — — — 舒张压/mmHg A组 269 76.5±7.4 65.4±8.1▲▲ 65.7±8.3▲▲ 170.52 < 0.01 63.087 B组 270 75.7±7.8 65.9±8.2▲▲ 66.5±8.5▲▲ 121.35 < 0.01 66.777 C组 270 77.2±8.0 66.7±7.7▲▲ 67.3±8.7▲▲ 141.54 < 0.01 66.327 F — 2.54 1.81 2.39 — — — P — > 0.05 > 0.05 > 0.05 — — — MS组内 — 59.873 64.045 72.281 — — — HR/(次/分) A组 269 78.9±12.5 75.7±11.7▲▲ 76.7±10.8▲ 5.28 < 0.01 136.593 B组 270 77.8±13.6 74.9±12.8▲ 75.7±11.4 3.80 < 0.05 159.587 C组 270 80.2±14.2 77.5±13.3#▲ 78.3±11.6# 3.04 < 0.05 171.030 F — 2.15 3.01 3.65 — — — P — > 0.05 < 0.05 < 0.05 — — — MS组内 — 180.981 159.234 127.066 — — — SpO2/% A组 269 97.73±1.24 95.20±4.35▲▲ 96.35±1.38▲▲■■ 57.90 < 0.01 7.455 B组 270 97.68±1.30 95.28±4.38▲▲ 96.80±1.40**▲▲■■ 52.29 < 0.01 7.612 C组 270 97.69±1.35 95.25±4.35▲▲ 96.75±1.45**▲▲■■ 53.69 < 0.01 7.616 F — 0.11 0.02 8.24 — — — P — > 0.05 > 0.05 < 0.01 — — — MS组内 — 1.684 19.010 1.989 — — — q检验:与A组比较**P < 0.01;与B组比较#P < 0.05,##P < 0.01;与用药前比较▲▲P < 0.01;与用药后1 min比较■■P < 0.01 表 2 3组病人丙泊酚注射痛的发生情况及病人满意率比较[n; 百分率(%)]
分组 n 重度疼痛 中度疼痛 轻度疼痛 无痛 疼痛发生 满意 A组 269 20(7.43) 57(21.19) 75(27.88) 117(43.49) 77(28.62) 225(83.64) B组 270 10(3.70) 15(5.56) 50(18.51) 195(72.22) 25(9.26)* 255(94.44) * C组 270 0(0.00) 4(1.48) 35(12.96) 235(87.03) 4(1.48)*# 268(99.26)*# Hc — 128.32 49.42 P — < 0.01 < 0.01 与A组比较*P < 0.05;与B组比较#P < 0.05 表 3 3组病人发生不良反应的比较[n; 百分率(%)]
分组 n 低SpO2 低血压 低心率 恶心呕吐 体动 A组 269 35(13.01) 20(7.43) 17(6.32) 2(0.74) 5(1.90) B组 270 36(13.33) 21(7.78) 17(6.30) 2(0.74) 5(1.85) C组 270 36(13.33) 20(7.47) 18(6.67) 1(0.37) 5(1.85) χ2 — 0.02 0.03 0.04 0.40 0.00 P — > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 -
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