静脉预注硫酸镁抑制丙泊酚注射痛的临床研究

目的:评价静脉预注硫酸镁对丙泊酚注射痛的防治作用。方法:160例ASAⅠ～Ⅱ拟行择期外科、妇科手术患者,随机分为M、L、K及S组,每组40例。右侧手背静脉置入20 G套管针作为试验用药及全麻诱导通路,距腕部5 cm处扎橡皮静脉止血带。M组、L组、K组、S组分别静脉注射20 mg/kg硫酸镁、0.5 mg/kg利多卡因、0.3 mg/kg氯胺酮及生理盐水5 ml。注药1 min后松开止血带,以0.5 ml/s静脉注射1%丙泊酚2 mg/kg。以口述描绘评分法(VRS)评估各组患者丙泊酚注射痛的发生率及其严重程度。记录给药前、松开止血带后、麻醉诱导完成后、气管插管即刻各组患者的MAP、HR。结果:M组、L组、K组及S组丙泊酚注射痛发生率分别为25%、55%、50%和95%,M组、L组、K组注射痛发生率均明显低于S组(P0.01);M组与L组丙泊酚注射痛发生率差异有统计学意义(P0.05);M组与K组、L组与K组丙泊酚注射痛发生率差异均无统计学意义(P0.05)。M组、L组、K组与S组比较,丙泊酚注射痛的严重程度均明显下降(P0.01);而M组、L组与K组间丙泊酚注射痛的严重程度差异均无统计学意义(P0.05)。各组患者的MAP、HR基本稳定。结论:结合止血带技术,静脉预注20 mg/kg硫酸镁、0.5 mg/kg利多卡因、0.3 mg/kg氯胺酮均能有效抑制丙泊酚注射痛的发生及其严重程度,且对血压、心率影响轻微,其中以硫酸镁效果最佳。

Clinical research of intravenous pretreatment with magnesium sulfate for inhibiting propofol-induced pain

Objective:To assess the efficacy of intravenous pretreatment with magnesium sulfate on propofol injection-induced pain.Methods:One hundred and sixty ASA Ⅰ-Ⅱ patients undergoing general anaesthesia were rando mly allocated into four groups:M,L,K and S group(forty in each group).A 20-gauge catheter was inserted into vein on the back of right hand for drug injection and anaesthesia,and with a rubber venous tourniquet 5 cm near wrist.In M,L,K and S group,patients were pretreated with i.v 20 mg/kg of magnesium sulfate(M),0.5 mg/kg of lidocaine(L),0.3 mg/kg of ketamine(K),and 5 ml normal saline(S),respectively.The occlusion was released after 1 min,2 mg/kg of propofol was injected into vein by the infusion at 0.5 ml/s.The incidence and intensity of pain was assessed by verbal rating scales(VRS).Patients′ MAP and HR were recorded at the point of before administration,tourniquet released,after induction of anesthesia and endotracheal intubation.Results:The incidence of pain in M group was 25% compared to 55% for L group,50% for K group and 95% for S group.The incidence and intensity of pain in all groups were significantly lower than in S group(P<0.01).The incidence of pain in M group was significantly lower than in L group(P<0.05),and was similar to K group;K group was similar to L group(P>0.05).The intensity of pain in M group was significantly lower than in L,K and N group(P<0.01),respectively,and there were no statistical differences in M,L and K group(P>0.05).There were no significant differences in MAP and HR between all groups.Conclusions:Combined with tourniquet technique,intravenous pretreatment with magnesium sulfate,lidocaine and ketamine are effective in attenuating propofol-induced pain.However,it has been observed that pretreatment with magnesium sulfate was the most effective.