静脉注射利多卡因通过其局麻作用而非全身作用减轻异丙酚注射痛  

The mechanism of intravenous lidocaine in alleviation of injection pains by intravenous propofol

作　　者：梁凌[1] 黄品婕[2] 罗晨芳[2] 罗刚健[2] 

机构地区：[1]广东省佛山顺德乐从医院麻醉科,528315 [2]中山大学附属第三医院麻醉科,广州市510630

出　　处：《实用医学杂志》2015年第12期2017-2020,共4页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2011B031800078)

摘　　要：目的:探讨利多卡因减轻异丙酚注射痛机制是通过其对血管壁的局部麻醉作用还是通过作用于神经中枢的全身作用。方法:选择在静脉全麻下行胃肠镜检的患者430例,根据诱导方式不同随机分为:A组,右手背最大静脉予生理盐水2 m L;B组,右手背最大静脉给予利多卡因40 mg;C组,左侧手背最大静脉给予利多卡因40 mg,3组给予上述预处理液2 min后,右侧对称静脉泵注异丙酚(总量为2 mg/kg)。异丙酚泵注量达0.5 mg/kg时,行VRS评分。酌情追加异丙酚。记录患者平均动脉压和心率变化。结果:无痛率:B组低于A和C组。与注射前相比,注射后1、3、5 min平均动脉压有下降。与注射前比较,注射后5min心率有下降。结论 :同条手背静脉预注利多卡因40 mg可以减少异丙酚注射痛。一侧手背静脉预注利多卡因40 mg不能减轻另一侧手异丙酚注射痛,考虑利多卡因减轻异丙酚注射痛主要以局部作用为主。Objective To study the mechanism of lidocaine injection in the alleviation of pains of propofol injection. Methods 430 patients, who underwent elective gastrointestinal endoscopy under general anesthesia , were randomly assigned into 3 groups： group A received 2 mL NS intravenous injection on the right dorsal hand;group B received 40 mg Lidocaine intravenous injection on the right dorsal hand and group C received 40 mg lidocaine intravenous injection on the left dorsal hand. All groups received 2 mg/kg Propofol intravenous injectionon the right dorsal hand at the rate of 20 mL/min. The injection pains were evaluated while the dosage reached 1/4 of the total （2 mg/kg）. The left dosage of Propofol and 50 μg Fentanil were pumped after evaluation. Propofol dosage was added when needed. Mean arterial pressure （MAP） and heart rate （HR ） were recorded before Propofol injection and 1, 3, 5 minutes after Propofol injection. Results VRS comparisons： Tthe rate of pain incidence of group B was significantly lower than those of group A and C. MAP were declined dramatically at the time points of 1 minute, 3 minutes and 5 minutes after propofol injection, as compared to before propofol injection. The HR was declined dramatically 5 minutes after propofol injection. Conclusion Intravenous Lidocaine of 40 mgcould reduce Propofol-induced injection pain of the same vein. Local effect of Lidocaine but not its systemic function may play an important role in reducing Propofol-induced injection pain.

关 键 词：异丙酚 注射痛 利多卡因 VRS评分 

分 类 号：R614[医药卫生—麻醉学]