上肢不同部位丙泊酚静脉注射疼痛的比较性研究_静脉注射丙泊酚

　　[摘要] 目的 进行上肢不同部位在丙泊酚静脉注射时疼痛的比较性研究与预防。 方法 选择ASA分级Ⅰ～Ⅱ级447例，在丙泊酚全凭静脉麻醉下实施上消化道内镜诊疗，将患者随机分为肘正中静脉组（EI组）、桡静脉组（RI组）及手背静脉组（HI组），每组149例。EI组在无痛上消化道内窥镜诊疗下于肘正中静脉缓慢匀速注射丙泊酚注射液；采用同样方法对RI组与HI组注射，除常规连续监测收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）外，采用疼痛视觉模拟评分（VAS），三组除记录麻醉药物用量和辅助用药情况，均需连续监测患者呼吸、血流动力学变化以及不良反应等内容。 结果 丙泊酚推注可使局部出现刺激性胀痛与放射性疼痛，HI组与RI组较EI组疼痛明显，三组VAS评分比较差异有高度统计学意义（P ＜ 0.01），EI组局部疼痛减轻，但放射痛仍然存在。实施护理干预、缓慢诱导、匀速注射及复合利多卡因等预防注射痛效果明显。 结论 上肢不同部位丙泊酚静脉注射痛比较显示，肘正中静脉、桡静脉与手背静脉疼痛依次递增，采取复合利多卡因的方法则能有效预防。
　　[关键词] 丙泊酚注射液；上消化道内窥镜诊疗；上肢；注射痛；护理干预
　　[中图分类号] R472 [文献标识码] C [文章编号] 1673-7210（2012）08（b）-0166-03
　　Comparative study on Propofol intravenous injection pain in different parts of upper limbs
　　ZHANG Yan QIN Yuanling ZHANG Yingxian▲
　　The First Affiliated Hospital of He"nan Universty of TCM, He"nan Province, Zhengzhou 450000, China
　　[Abstract] Objective To observe the upper limbs in different parts of the propofol injection pain research and prevention. Methods 447 patients of ASA physical status Ⅰ-Ⅱ were selected, who were given the diagnosis and treatment of upper gastrointestinal endoscopy under Propofol total intravenous anesthesia, and randomly divided into the median cubital vein group (EI group), the radial vein group (RI group) and the dorsal hand veingroup (HI group), each group had 149 cases. EI group was given Propofol injection in median cubital vein with the diagnosis and treatment of painless digestive tract endoscopy; the same way as RI group and HI group were injected, in addition to the conventional continuous monitoring of SBP, DBP, HR, SpO2, the pain visual analogue scale (VAS) was used, unless the record of the narcotic drug dosage and adjuvant need to be record, patient respiration, hemodynamic changes and adverse reactions continuous were also monitored. Results Propofol could make skin appeared local irritating pain and radiating pain, the pain of HI group was obvious compared with the RI group than the EI group, which VAS score had significant difference (P < 0.01), the local pain of EI group released, but radiating pain still existed. Nursing intervention, slow induction, uniform injection and Lidocaine for prevent injection had a obvious effect. Conclusion Comparison of pain on injection by Propofol in the different parts of the upper limb shows that the median cubital vein, radial vein and dorsal hand vein pain in ascending order, taking Lidocaine is effective in preventing.
　　[Key words] Propofol Injection; Upper gastrointestinal endoscopy clinics; Upper limbs; Pain on injection; Nursing intervention