李婷婷

[摘要] 目的 观察依托咪酯对异丙酚静脉麻醉患者注射痛及脑状态指数的影响。 方法 选择2019年9～11月门诊胃镜中心择期行无痛胃肠镜检查的患者89例，男女不限，年龄18～65岁，ASAⅠ～Ⅱ级，随机分为实验组（E组，44例）和对照组（N组，45例）。E组静脉注射依托咪酯0.05 mg/kg，N组静脉注射生理盐水2 mL，60 s后都以5 mg/s的速度静脉推注异丙酚，直至患者肌肉松弛睫毛反射消失。观察静脉推注异丙酚20 s内，患者在意识清醒状态下主诉有无注射痛;观察患者的脑状态指数：疼痛指数（Pi）和镇静指数（WLi）。 结果 两组异丙酚注射痛的发生率，差异有统计学意义（P<0.01）。两组Pi值差异有统计学意义（P<0.05）。 结论 （1）预给小剂量的依托咪酯可以降低静脉麻醉患者异丙酚注射痛的发生率及Pi值。（2）脑电疼痛指数（Pi）为疼痛的监测和评估提供了一种更为客观的方法。

[关键词] 异丙酚;注射痛;依托咪酯;脑状态指数

[中图分类号] R614          [文献标识码] B          [文章编号] 1673-9701（2020）16-0121-03

Effect of etomidate on injection pain and brain state index in the patients with propofol intravenous anesthesia

LI Tingting

Department of Anesthesiology， Shenzhen University General Hospital， Shenzhen   518055， China

[Abstract] Objective To observe the effect of etomidate on injection pain and brain state index in patients undergoing propofol intravenous anesthesia. Methods From September to November 2019， 89 patients who underwent painless gastroscopy at the outpatient gastroscopy center were selected. They were either male or female， within ages of 18 to 65 years old， and with ASA grades Ⅰ to Ⅱ. They were randomly divided into experimental group（44 cases in group E） and the control group（45 cases in group N）. Group E was given intravenous injection of etomidate of 0.05 mg/kg， and group N was given intravenous injection of 2 mL saline. After 60 s， propofol was injected intravenously at a rate of 5 mg/s until the patient's muscle relaxed and eyelash reflex disappeared. Within 20 s of propofol intravenous injection， whether the patients complained of injection pain in the conscious state was observed; The patient's brain state indices： pain index（Pi） and sedation index（WLi） were observed. Results The difference in the incidence rate of propofol injection pain between the two groups was statistically significant（P<0.01）. The difference in the Pi value between the two groups was statistically significant（P<0.05）. Conclusion （1）Pre-administration of low-dose etomidate can reduce the incidence rate and Pi value of propofol injection pain in the patients undergoing intravenous anesthesia. （2）EEG pain index（Pi） provides a more objective method for pain monitoring and evaluation.

[Key words] Propofol; Injection pain; Etomidate; Brain state index

異丙酚作为一种临床应用最广泛的静脉麻醉药，时效短、可控性强是其主要的优点。异丙酚的不良反应中，注射痛尤为常见和突出[1]。静脉注射异丙酚后5～20 s内，患者常感到注射部位的疼痛，呈烧灼样。异丙酚注射痛的发生率，成人占28%～90%[2]，部位为手背时30%～80%[3]。不仅增加患者给药时的焦虑和恐惧，不利于术中麻醉的平稳，也降低患者术后对舒适化医疗的满意度。目前临床上有多种方法降低注射痛的发生率[4]，预先给予小剂量的镇静药依托咪酯就是方法之一[5]。

疼痛是不愉快的躯体感觉，也是不愉悦的情感经历，与组织损伤有关或与可能存在的组织损伤有关。疼痛感是患者主观的，目前还没有一种有效并客观的用来评估疼痛的方法。迄今为止学术界公认，分析脑电波的工具中，小波算法最适合[6-7]。……