古玲玲

[摘要] 目的 探讨瑞芬太尼和利多卡因对丙泊酚注射痛预防作用的效果。 方法 收集2014年1月～2015年9月择期行妇科手术的女性患者150例，随机分为3组：R、L、C组，每组50例。R组静脉预注射1 μg/kg瑞芬太尼；L组静脉预注射利多卡因40 mg；C组静脉预注射等容量生理盐水。观察并记录3组丙泊酚注射痛发生率和程度，心动过缓（<50/min）、呛咳、低血氧饱和度（SpO2<90%）、恶心、呕吐不良反应以及输注并发症发生情况。 结果 丙泊酚注射痛的发生率在R、L、C组中分别为22%、42%、76%，差异有统计学意义（P<0.01）。R组注射痛发生率低于L组，差异有统计学意义（P<0.05）。C组重度注射痛发生率高于R、L组，差异有统计学意义（P<0.01）。R组有3例患者发生呛咳，各组患者严重心动过缓、呛咳、低血氧饱和度、恶心、呕吐不良反应发生率差异无统计学意义（P>0.05）。24 h回访，3组患者均未发生输注侧疼痛、肿胀、血管变硬等输注并发症。 结论 预注射利多卡因40 mg和瑞芬太尼1 μg/kg均能减轻丙泊酚注射痛，瑞芬太尼的效果优于利多卡因，安全可靠。

[关键词] 瑞芬太尼；利多卡因；丙泊酚；注射痛

[中图分类号] R971+.2 [文献标识码] A [文章编号] 1674-4721（2016）02（c）-0056-04

[Abstract] Objective To explore the preventive effect of remifentanil and lidocaine preventing propofol-induced injection pain. Methods From January 2014 to September 2015，150 female patients scheduled for gynecological surgery were collected and evenly divided into 3 groups in random：group R，L ，C.Group R was given 1 μg/kg remifentanil for intravenous preinjecting，group L was given 40mg lidocaine for intravenous preinjecting，and group C was given the same volume of normal saline for intravenous preinjecting.The incidence rate and degree of injection pain caused by propofol in three group was observed and recorded respectively，as well as adverse reactions including severe bradycardia （<50 times/min），bucking，low blood oxygen saturation （SpO2<90%），nausea and vomiting and infusion complication. Results The incidence rate of injection pain by propofol in group R，L，and C was 22%，42%，and 76% respectively，and there was a statistical difference （P<0.01）.The incidence rate of injection pain in group R was lower than that in group L with a statistical difference （P<0.05）.In group C，the incidence rate of severe injection pain was higher than that in group R and group L，which was displayed a statistical difference （P<0.01）.Three cases occurred with bucking in group R.There was no statistical difference of the incidence rate of adverse reaction including severe bradycardia，bucking，low blood oxygen saturation，nausea or vomiting （P>0.05）.During 24-hour follow-up，there was no infusion complications like pain，swelling，and hardened blood vessel in the affected side. Conclusion Pre-injection of 40 mg lidocaine and 1 μg/kg remifentanil both can alleviate injection pain caused by propofol， and effect of remifentanil is better than lidocaine，and it is safe and reliable.

[Key words] Remifentanil；Lidocaine；Propofol；Injection pain

丙泊酚具有起效快、苏醒迅速、可控性强等优点，是目前临床应用最广泛的静脉麻醉药之一，但局部注射痛是其常见的不良反应，发生率：成人为28%～90%，儿童为28%～85%[1]。这种疼痛可引起患者明显不适，使患者产生恐惧、烦躁的心理。利多卡因是减轻丙泊酚注射痛的一种经济、有效的药物，用药方式主要有：预注、与丙泊酚混合使用及静脉闭塞后静脉注射，但3种方式均不能完全消除疼痛。瑞芬太尼为新型短效阿片类受体激动剂，镇痛作用强，作用时间短，已被广泛用于临床麻醉。本研究观察预注射瑞芬太尼和利多卡因对丙泊酚注射痛预防作用的效果，现报道如下。

1 资料与方法

1.1 一般资料

收集2014年1月～2015年9月在本院择期行妇科手术女性的患者150例。美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级。所有患者对本次研究均知情且通过医学伦理委员会批准。……