不同长度滚轮微针预处理对利多卡因表面麻醉桡动脉穿刺的镇痛效果  

Pretreatment with different lengths of microneedle roller for lidocaine-induced topical anesthesia in radial artery puncture

作　　者：刁枢[1] 师小伟[1] 张立超[1] 夏伟[1] 刘奇[1] 

机构地区：[1]上海市第七人民医院麻醉科,上海200137

出　　处：《上海医学》2014年第8期648-651,共4页Shanghai Medical Journal

基　　金：上海市卫生局科研课题资助项目(20114262)

摘　　要：目的观察不同长度滚轮微针预处理对利多卡因表面麻醉下行桡动脉穿刺镇痛效果的影响。方法选取美国麻醉医师学会（ASA）分级I或Ⅱ级行择期手术的老年患者90例，按随机数字表分入3组，每组30例。对照组患者仅以浸满2％利多卡因1mL的吸水棉覆盖15min后行桡动脉穿刺，微针500预处理组和微针750预处理组患者分别采用长度为500和750btm的滚轮微针预处理和利多卡因表面麻醉后行桡动脉穿刺。采用疼痛视觉模拟评分（VAs评分）和Wong-baker面部表情量表评估穿刺疼痛程度，统计穿刺一次成功率和患者满意率，记录穿刺前后即刻生命体征变化，穿刺前后皮肤情况和其他不良反应发生情况。结果对照组桡动脉穿刺后即刻的心率、收缩压、舒张压和呼吸频率均较同组穿刺前显著升高（P值均〈0．05），微针500预处理组和微针750预处理组穿刺前后各项生命体征指标的差异均无统计学意义（P值均〉O．05）。微针500预处理组和微针750预处理组的疼痛VAS评分均显著低于对照组（P值均〈0．05）；Wong—baker面部表情量表判定结果O～2级患者的构成比均显著高于对照组（P值均〈0．05），3～4级患者的构成比均显著低于对照组（P均〈0．05）；穿刺一次成功率均显著高于对照组（P值均〈0．05）。微针500预处理组的患者满意率显著高于对照组和微针750预处理组（P值均〈0．05）。微针500预处理组预处理后皮肤发红的发生率显著高于对照组（P《0．05），微针750预处理组预处理后皮肤发红和48h后穿刺部位皮肤瘀青的发生率显著高于对照组和微针500预处理组（P值均〈0．05）。3组患者均未出现穿刺处皮肤破损和感染。结论长度为500“m的滚轮微针预处理的安全性好，可增强利多卡因表面麻醉下行桡动脉穿刺的镇痛效果。Objective To evaluate the analgesic effect of pretreatment with different length of microneedle roller for lidocaine-induced topical anesthesia in radial artery puncture. Methods Ninety elderly patients with America society of Anesthesiologists （ASA） grade I or Ⅱ undergoing selective operation were randomized into three groups （n = 30）. Group I received topical anesthesia （2% lidocaine, 1 mL, 15 min） before radial artery puncture. Group Ⅱ and Ⅲ received pretreatment of 500 μm and 750 μm microneedle roller before topical anesthesia, respectively. Visual analog scale （VAS）, Wong-baker scale, first puncture rate, patient satisfaction rate and adverse events after puncture were recorded and compared. Results In group I , heart rate, systolic pressure, diastolic pressure and respiratory rate were significantly increased immediately after puncture （all P〈0.05）. However, there were no significant differences in the above-mentioned parameters before and after puncture in both group Ⅱ and Ⅲ （all P〈0.05）. VAS scores in group Ⅱ and Ⅲ were significantly lower than that in group I （both P〈0.05）. The percentage of Wong-baker scale grade 0-2 in group Ⅱ and Ⅲ were significantly higher than that in group I （both P〈0.05）, while the percentage of Wong-baker scale grade 3-4 in group Ⅱ and Ⅲ were significantly lower than that in group I （both P〈0.05）. The first-puncture success rates in group Ⅱ and Ⅲ were significantly higher than that in group I （both P〈0.05）. Patient＇s satisfaction rates in group in group Ⅱ were significantly higher than those in group I and Ⅲ （both P〈0.05）. The incidence of skin redness in group Ⅱ was significantly higher than that in group T （ P〈0.05）. The incidences of skin redness and skin bruise in group Ⅲ were significantly higher than those in group I and Ⅱ （all P〈0.05）. No severe skin injury or infection occurred in the three groups. Conclusion Pretreatment with 500 μm microneedle roller is safe an

关 键 词：针长度 滚轮微针 预处理 利多卡因 表面麻醉 桡动脉穿刺 

分 类 号：R614[医药卫生—麻醉学]