结构脂肪乳和中长链脂肪乳临床副作用比较

目的观察和比较结构脂肪乳（sTG）和传统中／长链脂肪乳（MCT／LCT 1：1）临床副作用,以减少肠外营养并发症的发生。方法选择我科50例需要进行中等腹部手术且术前ALT和AST均正常的患者,随机分为实验组和对照组,术后连续5d分别给于结构脂肪乳（力文。）和中／长链脂肪乳（力能。）进行肠外营养,分别观察两组患者副反应（恶心呕吐、头痛、发热）和肝功能指标（ALT、AST）。结果实验组与对照组的患者恶心、呕吐的发生率分别为44％与72％,头痛的发生率分别为40％与68％,发热的发生率分别为36％与64％;实验组与对照组ALT及AST均在正常范围内,实验组均低于对照组,ALT分别为（24±0．25）U／L与（28±0．35）U／L,AST分别为（20±0．19）U／L与（26±0．31）U／L。结论结构脂肪乳较传统中／长链脂肪乳的副作用小,两种脂肪乳制剂均不造成肝脏功能的明显损害。     

The injection pain of propofol with different emulsion

BACKGROUND: Incidence and intensity of pain on intravenous injection of propofol were assessed with emulsion of long-chain/medium-chain triglycerides (LCT/MCT, 50: 50) and only long-chain triglycerides (LCT, 100) in patients undergoing different elective surgical interventions in this prospective, randomized, cross over and double-blinded study. METHODS: 1) Forty six patients were assigned to two groups. One group received 0.2 mg x kg(-1) LCT/ MCT propofol prior to LCT propofol administration. The other group received 0.2 mg x kg(-1) LCT propofol prior to LCT/MCT propofol administration. Pain elicited upon questioning was assessed with each injection in the two groups. Patients were asked to grade the pain as VAS of 0 to 100 mm. 2) Fifty one patients were randomly assigned to two groups. One group received 0.4 mg x kg(-1) LCT propofol. The other group received 0.4 mg x kg(-1) LCT/MCT propofol. Patients were asked to grade the pain as VAS of 0 to 100 mm. RESULTS: Pain of LCT propofol injection was stronger than LCT/MCT propofol. As incidence of 0.4 mg x kg(-1) propofol injection, VAS on LCT/MCT propofol and LCT propofol gave score as 0 and 23.5 (P=0.0019). CONCLUSIONS: Propofol with emulsion of long- and medium-chain triglycerides appears to reduce the injection pain than with emulsion of only long-chain triglycerides.     

Fentanyl prevents the pain at the site of propofol injection]

The effect of fentanyl, administered immediately before propofol, when pain is experienced at the site of propofol injection was studied in 28 children undergoing elective surgery. The intravenous administration of fentanyl (2 micrograms/kg) significantly reduced such pain compared with a control group receiving saline. The results suggest that the administration of fentanyl may be a valid procedure in relieving pain on injection of propofol.     

不同暗示语言防治患儿丙泊酚注射痛效果的比较

目的探讨不同语言暗示在患儿丙泊酚注射时对疼痛反应的影响。方法选取我院拟接受全麻下择期手术的患儿151例,男140例,女11例,年龄4～12岁,ASAⅠ或Ⅱ级,随机分为两组:"一般工作语言"组(N组)和"积极语言"组(P组)。两组患儿在丙泊酚推注前分别给予不同的暗示语言。N组被告知:"我现在要在你手上推麻醉药,你的手臂会有点刺痛,你有不舒服就说,不要动来动去。" P组被告知:"现在我要在你手上推麻醉药,你的手臂可能会有点凉凉麻麻的,这个过程很舒服。"采用视觉模拟焦虑量表(VAS-A)评估患儿在手术床上躺平时(T_1)以及暗示语言干预后(T_2)时的焦虑评分,采用四分法记录丙泊酚推注时的疼痛分级。结果与T_1时比较,T_2时P组焦虑评分明显降低(P0.05),N组焦虑评分明显升高(P0.05)。T_2时P组焦虑评分明显低于N组(P0.05)。P组疼痛发生率明显低于N组(P0.05)。结论与一般工作语言比较,积极语言可明显减轻患儿焦虑感,并降低丙泊酚推注时疼痛发生率。     

Comparison of Propofol-Lipuro with propofol mixed with lidocaine 10 mg on propofol injection pain

A common drawback of propofol is pain on injection and lidocaine is commonly mixed with propofol to reduce its incidence and severity. We conducted a randomised, prospective, double-blind study to compare injection pain following the administration of two different formulations of propofol in 200 unpremedicated ASA I-III adult patients scheduled for elective surgery under general anaesthesia. Patients were allocated randomly into two groups to receive either Propofol-Lipuro without added lidocaine or Diprivan mixed with lidocaine 10 mg. Five ml of the study solution was injected at a constant rate over 15 s and patients graded any associated pain or discomfort using a four-point verbal rating scale. The incidence of propofol injection pain was virtually identical in both study groups with 37/98 (38%) patients experiencing pain or discomfort following Propofol-Lipuro compared with 35/98 (36%) after Diprivan (p = 0.88). We observed no significant difference in pain scores between the groups (p = 0.67). Moderate or severe injection pain was experienced by 12/98 (12%) patients given Propofol-Lipuro compared with 8/98 (8%) given Diprivan (p = 0.48).     

两种脂肪乳对老年胃肠肿瘤患者术后营养疗效的比较

目的比较中长链脂肪乳及长链脂肪乳对老年胃肠肿瘤患者术后营养的疗效。方法29例老年胃肠肿瘤手术患者分为中长链脂肪乳组(MCT组,15例)和长链脂肪乳组(LCT组,14例),术后第2～7天共进行6d的肠外营养支持。除脂肪乳不同外,均给予等氮、等热卡的肠外营养,观察累积氮平衡、血浆蛋白、脂质代谢及与感染有关的并发症和术后住院天数等。结果术后经肠外营养MCT组获得正氮平衡,为(27.3±24.0)mg·kg-1·(6d)-1,而LCT组为(-17.5±16.2)mg·kg-1·(6d)-1。术后血浆蛋白水平均降低,LCT组前白蛋白的降幅为(-0.06±0.03)g/L,明显高于MCT组的(-0.02±0.03)g/L,差异有显著性意义(P<0.05)。两组患者的各项血脂水平手术前后变化均不明显。术后感染性并发症MCT组2例,LCT组3例。结论中长链脂肪乳对老年胃肠肿瘤患者术后的营养疗效比长链脂肪乳好。     

中链及长链脂肪乳剂的代谢特点及其临床应用

自欧洲以 Ｗｒｅｔｌｉｎｄ为代表的一批学者不懈地研究和使用以大豆油为基础、卵黄磷脂为乳化剂、甘油为张力剂的脂肪乳剂Ｉｎｔｒａｌｉｐｉｄ以来,脂肪乳剂的静脉应用被认为是肠外营养（ＰＮ）发展的重要里程碑之一。然而,对脂肪乳剂的研究和应用有诸多不同的观点,不同作者报告的临床及实验结果也不尽一致。目前普遍关注的是脂肪乳剂对免疫功能的影响、脂肪蓄积及生物活性物质的代谢等方面。近年来,对于中、长链混合脂肪乳剂（ＭＣＴ／ＬＣＴ）的研究报道逐渐增多,普遍认为其颇具特点。为此,全面了解中、长链脂肪乳剂的体内代谢特…     

Ephedrine reduces the pain from propofol injection

One hundred seventy-six patients (ASA physical status I or II) presenting for elective surgery were randomly allocated into six study groups to compare the incidence of propofol-induced pain after pretreatment with different doses of ephedrine as compared with lidocaine. Patients in Group P (n = 30) received saline placebo; patients in Group L (n = 30) received 2% lidocaine 40 mg; patients received ephedrine 30 microg/kg (Group E30, n = 28), 70 microg/kg (Group E70, n = 30), 110 microg/kg (Group E110, n = 30), and 150 microg/kg (Group E150, n = 28), respectively, followed 30 s later by propofol 2.5 mg/kg. A blinded anesthesiologist asked the patient to evaluate the pain score (verbal rating scale and face pain scale). The incidence and intensity of pain was less in the lidocaine and ephedrine groups than in the placebo group (P < 0.01). Before tracheal intubation, the arterial blood pressure was decreased in the P and L groups, and after intubation, hemodynamics were increased in the E110 and E150 groups, respectively (P < 0.05). We concluded that pretreatment with a small dose of ephedrine (30 and 70 microg/kg) reduced the incidence and intensity of propofol-induced pain with a lesser decrease in arterial blood pressure than from propofol alone in lidocaine pretreatment. IMPLICATIONS: Propofol is a widely used IV anesthetic for the induction of anesthesia, but it often causes local pain when administered into peripheral veins. A small dose of ephedrine reduces the incidence and intensity of the pain without significant adverse hemodynamic effects during induction.     

A lidocaine/metoclopramide combination decreases pain on injection of propofol

PURPOSE: Injection pain is a well-known adverse effect of propofol which distresses patients. Lidocaine pretreatment is the most popular method for reducing this pain but this drug cannot entirely eliminate the problem. The purpose of this study was to examine the analgesic effect of lidocaine/metoclopramide combination, compared with lidocaine alone, during propofol injection. METHODS: In a randomized, double-blind, placebo-controlled trial, 90 patients, 40 males and 50 females, scheduled for elective plastic surgery received either lidocaine 20 mg plus metoclopramide 10 mg iv, lidocaine 20 mg iv, or placebo (saline); (n = 30 in each), with venous occlusion for one minute, followed by administration of propofol 0.5 mg.kg(-1) into a dorsal hand vein. Pain was assessed on a four-point scale (0 = none, 1 = mild, 2 = moderate, 3 = severe) during propofol injection. RESULTS: 25 patients (83%) complained of pain in the placebo group, compared with 12 (40%) in the lidocaine group (P < 0.05) and three (10%) in the combination group (P < 0.05). Pain score (median) was less in the lidocaine (0) and combination (0) groups than in the placebo group (2); (P < 0.05). The difference in the incidence of pain between the combination and lidocaine groups was significant (P < 0.05). CONCLUSION: A lidocaine/metoclopramide combination is more effective than lidocaine alone for reducing pain on injection of propofol in a peripheral vein.     

Nitrous oxide/oxygen mixture and the prevention of pain during injection of propofol

BACKGROUND AND OBJECTIVE: The incidence of pain associated with the injection of propofol still remains a problem. This study sought to examine the analgesic effects of inhaled nitrous oxide in oxygen on the prevention of propofol injection pain. METHODS: Nitrous oxide in oxygen was compared with a lidocaine (20 mg)-propofol mixture and with propofol alone (control) in a prospective, randomized, observer-blinded study. ASA I and II patients (n = 135) scheduled for elective surgical procedures were studied. A standard propofol injection technique and scoring system to measure the pain on injection was used. RESULTS: Demographic variables were similar between the study groups. Without analgesia (control) 26 of 45 patients (58%) reported pain on injection compared with 11 of 45 patients (24%) in both the nitrous oxide (95% CI: 14-52%, P = 0.001) and lidocaine groups (95% CI: 14-52%, P = 0.001). CONCLUSIONS: The inhalation of a nitrous oxide/oxygen mixture significantly reduces the incidence of pain during propofol injection. This therapeutic stratagem was as effective as a lidocaine-propofol mixture.     

Impact of time interval between remifentanil and propofol on propofol injection pain

Study ObjectiveTo determine the most effective time interval between remifentanil and propofol (Time_RP) for the prevention of propofol injection pain in association with remifentanil dosage.DesignProspective randomized study.SettingOperating room of a university hospital.PatientsSixty American Society of Anesthesiologists physical status 1 and 2 patients scheduled for elective surgery under general anesthesia.InterventionsPatients were randomly assigned to 1 of 3 groups to receive remifentanil at dosages of 0.25, 0.5, or 0.75 μg/kg over 30 seconds before the injection of 1% propofol 2 mg/kg. Time_RP was defined as the time interval from the initiation of the remifentanil injection to the initiation of the propofol injection. Time_RP for each subsequent patient was determined by the response of the previous patient using an up-and-down sequential allocation method. Injection pain caused by propofol was evaluated using a 4-point scale during the propofol injection.MeasurementsTime_RP50 was defined as the Time_RP at which propofol injection pain was absent in 50% of patients, and it was estimated using isotonic regression for each dose group.Main ResultsTime_RP50 was significantly lower in the remifentanil 0.75 μg/kg group (38.6 seconds, 83% confidence interval [CI], 35.6-45.0) than in the 0.5 μg/kg group (65.0 seconds; 83% CI, 52.5-75.0) or the 0.25 μg/kg group (66.6 seconds; 83% CI, 57.1-76.5).ConclusionsThe efficacy of remifentanil pretreatment for preventing propofol injection pain can be influenced by the time interval between remifentanil and propofol as well as the remifentanil dose.