2种溶媒肌肉注射蛇凝血素酶的效果比较

蛇凝血素酶是从巴西矛头蝮蛇的蛇毒中分离提纯的血凝酶,用于出血及出血性疾病的预防[1]和术前术后用药[2],安全性高且优于一般的止血药物[2],但是存在注射疼痛问题[3].我们在临床工作中发现在肌肉注射蛇凝血素酶时,用灭菌注射用水作为蛇凝血素酶的溶媒,患者疼痛难忍,而用0.9%氯化钠溶液作溶媒,注射时患者疼痛减轻,易于接受[4].因此,我们分别采用0.9%氯化钠溶液和灭菌注射用水作为蛇凝血素酶的溶媒,观察肌肉注射后患者的反应,现报道如下.     

两种溶媒肌内注射绒毛膜促性腺激素的效果比较

目的为肌内注射绒毛膜促性腺激素(HCG)寻找一种可减轻疼痛的有效溶媒.方法对两组患者肌内注射HCG时分别采用灭菌注射用水和0.9%氯化钠溶液作溶媒,用双盲法对患者注射后疼痛反应和局部反应进行观察.结果采用0.9%氯化钠溶液做溶媒比灭菌注射用水疼痛反应轻,差异有统计学意义(P<0.01).结论采用0.9%氯化钠溶液做溶媒肌内注射HCG,能有效缓解患者疼痛,是一种安全可靠的溶媒.     

使用不同溶媒稀释尿促性素后肌肉注射的疼痛观察与分析

目的减轻不孕症患者肌肉注射HMG后的疼痛。方法对100例不孕症患者采用自身对照,隔日注射法,分别用注射用水和生理盐水做溶媒稀释HMG进行肌肉注射后,采用视觉类比量表对患者的疼痛程度进行比较分析。结果2种方法肌肉注射患者疼痛程度差异有极显著意义(P值<0.01)。结论使用生理盐水注射液稀释HMG后,能减轻患者肌肉注射的疼痛,提高患者满意度。     

绒毛膜促性腺激素两种溶剂给药效果的研究

目的:比较绒毛膜促性腺激素(HCG)应用灭菌注射用水和生理盐水两种溶剂溶解后进行肌肉注射后疼痛效果。方法:将82例早孕先兆流产的病人根据随机的原则分为观察组和对照组注射HCG 1 000U,观察组40例采用生理盐水2mL溶解HCG干粉剂进行肌肉注射,对照组42例采用无菌注射用水2mL溶解HCG干粉剂进行肌肉注射。结果:观察组患者疼痛明显减轻,观察组疼痛发生率12.5%,对照组疼痛发生率95.2%。结论:用生理盐水溶解HCG注射效果明显优于用无菌注射用水溶解HCG。     

两种溶媒肌肉注射博莱霉素所致疼痛的比较

目的探讨博莱霉素(bleomycin,BLM)肌肉注射的一种疼痛较轻的溶媒。方法2组患者肌肉注射BLM时分别采用0.9%氯化钠溶液、灭菌注射用水做溶媒,观察注射后疼痛反应。结果采用0.9%氯化钠溶液做溶媒比灭菌注射用水做溶媒引起的疼痛反应有显著性差异(P<0.01)。结论肌肉注射BLM以0.9%氯化钠溶液为溶媒可有效减轻患者疼痛。     

使用不同溶媒稀释尿促性素后肌肉注射的疼痛观察与分析

目的减轻不孕症患者肌肉注射HMG后的疼痛.方法对100例不孕症患者采用自身对照，隔日注射法，分别用注射用水和生理盐水做溶媒稀释HMG进行肌肉注射后，采用视觉类比量表对患者的疼痛程度进行比较分析。结果2种方法肌肉注射患者疼痛程度差异有极显著意义（P值〈0．01）。结论使用生理盐水注射液稀释HMG后，能减轻患者肌肉注射的疼痛，提高患者满意度。     

两种溶媒肌肉注射博莱霉素所致疼痛的比较

目的 探讨博莱霉素(bleomycin,BLM)肌肉注射的一种疼痛较轻的溶媒.方法 2组患者肌肉注射BLM时分别采用0.9%氯化钠溶液、灭菌注射用水做溶媒,观察注射后疼痛反应.结果 采用0.9%氯化钠溶液做溶媒比灭菌注射用水做溶媒引起的疼痛反应有显著性差异(P＜0.01).结论 肌肉注射BLM以0.9%氯化钠溶液为溶媒可有效减轻患者疼痛.     

2种溶媒肌肉注射蛇凝血素酶的效果比较

蛇凝血素酶是从巴西矛头蝮蛇的蛇毒中分离提纯的血凝酶，用于出血及出血性疾病的预防和术前术后用药，安全性高且优于一般的止血药物，但是存在注射疼痛问题。我们在临床工作中发现在肌肉注射蛇凝血素酶时，用灭菌注射用水作为蛇凝血素酶的溶媒，患者疼痛难忍，而用0．9％氯化钠溶液作溶媒，注射时患者疼痛减轻，易于接受。因此，我们分别采用0．9％氯化钠溶液和灭菌注射用水作为蛇凝血素酶的溶媒，观察肌肉注射后患者的反应，现报道如下。     

两种溶媒配制皮试液疼痛程度的比较

目的选择1种可减轻患者皮试疼痛的溶媒。方法2组患者分别采用灭菌注射用水和0.9%生理盐水溶液做溶媒,用Mecill问答法观察患者皮试后疼痛的程度。结果采用0.9%生理盐水做溶媒比灭菌注射用水疼痛反应轻,有统计学差异（P〈0.01）。结论采用0.9%生理盐水做皮试液的溶媒可缓解患者疼痛,减轻患者对做皮试时的恐惧感,是一种值得提倡的方法。     

两种不同支点法肌肉注射所致局部疼痛的比较

[目的]比较肘支点法和腕支点法肌肉注射所致局部疼痛的程度。[方法]103例病人采用自身对照,分别用肘支点法和腕支点法在同侧臀大肌注射1次,每次注射后用视觉模拟评分法(VAS)对病人进行疼痛评估。[结果]肘支点法注射后病人VAS疼痛评分较腕支点法低(P0.05)。[结论]肘支点法肌肉注射所致局部疼痛程度轻,可作为临床和教学的选择方法。     

3种肌内注射缩宫素方法对患者疼痛程度的影响

目的观察3种肌内注射缩宫素方法对患者疼痛程度的影响。方法将90例患者随机分为3组,每组各30例及各100例次,分别采用常规注射法、留置气泡注射法、0.9%生理盐水稀释注射法对3组患者进行肌内注射缩宫素。比较3组患者注射后疼痛程度和局部反应情况。结果 3组患者肌内注射缩宫素疼痛程度比较,P〈0.01,差异具有统计学意义,其中采用0.9%生理盐水溶液稀释法比其他两组肌内注射时疼痛程度明显减轻,但是3组患者肌内注射缩宫素局部反应比较,P〉0.05,差异无统计学意义。结论采用0.9%生理盐水溶液稀释法肌内注射缩宫素能有效缓解患者疼痛程度,且安全可靠,不影响药物疗效,患者满意,值得临床推广应用。     

长效青霉素无痛肌肉注射方法的探讨

目的探讨减轻肌注长效青霉素给病人带来痛苦的方法,提高肌注治疗品质。方法通过对60例病人485人次采用利多卡因稀释、常规生理盐水及灭菌注射用水稀释分组肌注时及肌注后疼痛感的程度不同,进行效果比较。结果利多卡因稀释注射显著优于生理盐水及灭菌注射用水稀释注射。结论利多卡因稀释注射能减轻甚至能消除肌注疼痛,值得推广。     

Effects on muscle pain by intramuscular injection of granisetron in patients with fibromyalgia

We have previously reported that the level of 5-HT in the masseter muscle is increased in patients with fibromyalgia as compared with healthy subjects and that high intramuscular level of 5-HT is associated with muscle pain. We have also reported that injection of the 5-HT(3) receptor antagonist granisetron (GRA) into the masseter muscle of healthy subjects reduced pain induced by 5-HT and abolished allodynia/hyperalgesia. The aim of this study was to investigate whether GRA can influence pain and allodynia/hyperalgesia of the masseter muscle in patients with fibromyalgia. Eighteen female patients who met the criteria of fibromyalgia according to the American College of Rheumatology participated in the study. They were examined regarding pain intensity and pressure pain threshold (PPT) over the masseter muscle. One milliliter of GRA (1 mg/ml) was injected into the masseter muscle on one side and 1 ml of isotonic saline on the other side in a randomized and double-blind manner. After the injections, the pain intensity and PPT were recorded during 30 min. The pain intensity increased after injection of saline and to a lower degree after injection of GRA. The PPT increased after injection of GRA, while no such change was observed after saline. The difference between GRA and saline was, however, not significant. Eight of the patients responded to the GRA injection by an increase of PPT during the experimental period that differed from saline. They also showed a tendency to a lower increase of pain intensity after injection of GRA when compared to saline. In conclusion, the results of this study do not prove that injection of the 5-HT(3)-antagonist GRA into the masseter muscle influences local pain and allodynia/hyperalgesia in patients with fibromyalgia.     

肌内注射维生素K3导致局部疼痛的原因分析及处理对策

[目的]探讨肌内注射维生素K3导致局部疼痛的原因,并提出相应的处理对策。[方法]将60例注射维生素K3导致局部疼痛的患儿分为观察组和对照组,每组30例,观察组常规注射法出现疼痛后采用50%硫酸镁湿热敷及红外线烤灯照射,连续3 d,每天2次;对照组常规注射法出现疼痛后采用观察局部情况,下次注射时更换部位,比较两组患儿疼痛减轻的疗效。[结果]观察组患儿疼痛减轻率为96.7%,对照组为20.0%,差异有统计学意义(P<0.01)。[结论]采取50%硫酸镁湿热敷及红外线烤灯照射减少注射维生素K3导致局部疼痛的效果优于常规法。     

Effects of Intramuscular Anesthesia on the Expression of Primary and Referred Pain Induced by Intramuscular Injection of Hypertonic Saline

Intramuscular injection of hypertonic saline produces pain in the belly of the injected muscle (primary pain) and, often, pain that projects distally (referred pain). While it is known that referred pain can be induced during complete sensory block of the distal site, there is little evidence as to whether the perception of referred pain depends on ongoing input from the primary stimulus. We assessed whether blocking the noxious input following the induction of pain blocks the primary but not the referred pain. A cannula was inserted into the tibialis anterior muscle in 15 subjects (8 male, 7 female). In a quasi-random crossover design conducted over 2 experimental sessions, each subject received a bolus intramuscular injection of .5 mL of 5% hypertonic saline, followed 90 seconds later by either: A) A second bolus injection or; B) An injection of 2 mL lignocaine through the same cannula. Protocol A was followed 60 seconds later by either a sham injection or an injection of lignocaine, while protocol B was followed 60 seconds later by either a sham injection or an injection of hypertonic saline. Subjects mapped the areas of primary and referred pain, and rated the intensities at these sites every 30 seconds until the cessation of pain. In all subjects, the area and intensity of primary pain rapidly disappeared within 7.5 minutes of intramuscular lignocaine injection (P < .02 relative to the nonanesthesia condition). With the exception of 2 subjects, in whom the referred pain continued in the absence of primary pain, the referred pain declined in parallel with local pain: the mean total pain intensity declined by 74% in both regions. We conclude that the maintenance of referred muscle pain usually depends on ongoing noxious inputs from the site of primary muscle pain.PerspectiveReferred pain is a significant clinical problem, and commonly occurs with pain originating in muscle but not from skin. It is important to know the primary source of the pain so that treatment can be directed to this site rather to the site of referral.     

Regional head and face pain relief following lower cervical intramuscular anesthetic injection

BACKGROUND: Although cervical trigger point intramuscular injections are commonly used to relieve localized neck pain, regional head pain relief from lower cervical paravertebral injections has not been reported previously. PURPOSE: To evaluate the safety and efficacy of such injections in a selected group of patients with intractable head or face pain. METHODS: In a series of patients with chronic head or face pain, local anesthetic was injected into the lower cervical spine paravertebral musculature approximately 1 to 2 inches lateral to the seventh cervical spinous process. RESULTS: In addition to producing rapid relief of palpable scalp or facial tenderness (mechanical hyperalgesia and allodynia pain), this lower cervical intramuscular injection technique alleviated associated symptoms of nausea, photophobia, and phonophobia in patients with migrainous headache. CONCLUSION: Our results suggest that lower cervical intramuscular anesthetic injection may be an effective treatment for head or face pain.     

几种改良肌注方法在无痛注射中的研究现状

通过分析造成传统肌肉注射疼痛的原因，探讨几种缓解患者肌肉注射疼痛的不同方法。如按捏手法、按压法、调整进针角度法、控制进针深度法、使用局麻药物控制法、气泡封堵注射法、Z路径肌肉注射法、耳穴压豆法、两针头法、音乐疗法等在临床护理操作中的应用原理，同时比较各种方法的优缺点，根据患者不同的特质，选择适宜的肌肉注射的方法，从而最大程度减轻患者的注射疼痛，提高护理质量满意度。     

Experimental human muscle pain induced by intramuscular injections of bradykinin,serotonin, and substance P

After intramuscular (m. tibialis anterior) injection of three different algogenic substances, the pain intensity was continuously scored on a visual analogue scale (VAS) in eight volunteers. The subject drew the distribution of the local and referred pain areas on a map. Four times within the first hour after injection, the pressure pain–thresholds (PPTs) and supra pressure–pain thresholds were assessed at the injection point, 2 cm distal from the injection site, at the arm, and at the contralateral leg. Measurements were done before and after injection of 0.5 ml of the algogenic substance [bradykinin (BKN), serotonin (5-HT), substance P (SP)], and isotonic saline as control. Cutaneous sensitivity to mechanical stimuli was assessed with a Von Frey hair at the same location as PPT determinations. The pain intensity (VAS-peak) after BKN (2, 4, and 10 nmol) and 5-HT (2, 4, and 20 nmol) was significantly higher (p< 0.05) than after SP (0.2, 0.4, and 0.8 nmol) and isotonic saline. The VAS-peak after infusions of hypertonic saline was significantly higher (p< 0.05) compared with VAS-peaks after all other substances. A significantly larger (p< 0.05) local pain area was found after BKN compared with isotonic saline. After injections of hypertonic saline, the offsets of evoked pain were significantly longer (p< 0.05) and the local and referred pain areas were significantly larger (p< 0.05) compared with all other substances. There was no dose–response relation between the pain intensity and the different doses of BKN, 5-HT, and SP. PPTs and skin sensitivity were not affected by any of the injections. We conclude that under the present experimental conditions, BKN and 5-HT can produce low levels of muscle pain after intramuscular injection. In the used concentrations, however, BKN, 5-HT, and SP did not generate cutaneous or muscular hyperalgesia.     

Effect of adrenergic receptor activation on post-herpetic neuralgia pain and sensory disturbances

Patients with acute herpes zoster, and to a lesser extent post-herpetic neuralgia (PHN), have been reported to respond to local anesthetic blockade of the sympathetic nervous system. In animal models of nerve injury, local injection of adrenergic agonists after nerve injury, but not before, excites nociceptors. In some patients with chronic neuropathic pain, local application of norepinephrine evokes pain. In 15 subjects with PHN, the role of adrenergic receptors in PHN pain was assessed in a two-session double blind study comparing the response to cutaneous infiltration of epinephrine or phenylephrine (30 μg in 3 ml) with the response to normal saline in both the painfully affected skin and mirror-image normal skin. Two adjacent sites were studied on each side of the body, one site for injection and the other for measuring sensory effects of the injection. In the morning part of each session, mirror-image normal skin was injected. In the afternoon portion of each session, skin in the most painful area affected by PHN was injected. Injection of saline or the adrenergic agonist in normal skin produced mild and transient pain without development of allodynia and without affecting overall PHN pain intensity. In PHN skin, injection of saline and the adrenergic agonist produced an equivalent degree of transient pain that was slightly greater than injection into mirror-image normal skin. After injection of the adrenergic agonist into PHN skin, both overall PHN pain and allodynia severity were significantly greater than after saline injection, peaking at 10–15 min post-injection. Even when PHN has been present for years, adrenergic receptor stimulation in PHN skin increases pain, most likely through direct activation of C-nociceptors in the painful skin. Increased allodynia is most likely mediated centrally and driven by the increase in C-nociceptor input.