麻醉劑助推器在術前靜脈留置針無痛穿刺中的應用

林樺 謝興 趙仰旭 莫曉瓊 翟瑞金

【摘要】 目的 探討麻醉劑助推器輔助下快速達到靜脈留置針無痛穿刺的效果。方法 選取符合納入標準的患者306例，按抽簽法分為三組，A組102例，B組100例，C組104例。A組：在靜脈留置針穿刺前，使用麻醉劑助推器在穿刺部位進行局部麻醉后穿刺;B組：在靜脈留置針穿刺前20 min濕敷利多卡因后進行穿刺;C組：常規(guī)方法行靜脈留置針穿刺。比較穿刺前、穿刺后三組患者心率、平均動脈壓、疼痛評分變化情況及一次穿刺成功率、術中輸液外滲發(fā)生率。結果 穿刺前三組患者心率、平均動脈壓、疼痛評分比較差異均無統(tǒng)計學意義（P>0.05），使用18 G留置針為患者行靜脈穿刺后，三組患者心率、平均動脈壓、疼痛評分均較穿刺前增高（P<0.05），三組間患者心率、平均動脈壓、疼痛評分兩兩比較，差異有統(tǒng)計學意義（P<0.05或0.01）。其中，A組患者穿刺后心率、平均動脈壓、疼痛較穿刺前變化幅度最小，C組變化幅度最大。三組一次穿刺成功率比較差異有統(tǒng)計學意義（P<0.01），A組、B組一次穿刺成功率高于C組（P<0.05或0.01），A組一次穿刺成功率高于B組，但差異無統(tǒng)計學意義（P>0.05）。術中三組輸液外滲發(fā)生率比較差異有統(tǒng)計學意義（P<0.01），A組、B組術中輸液外滲發(fā)生率低于C組（P<0.05或0.01），但差異無統(tǒng)計學意義（P>0.05）。結論 麻醉劑助推器輔助可有效減輕靜脈留置針穿刺時的疼痛，達到無痛穿刺的滿意效果，提高穿刺的成功率，減輕患者痛苦。

【關鍵詞】 麻醉劑助推器;靜脈留置針;靜脈穿刺;疼痛

中圖分類號：R715.3 ? 文獻標志碼：A ? DOI：10.3969/j.issn.1003-1383.2019.07.005

【Abstract】 Objective To investigate the effect of quickly reaching the painless puncture of venous indwelling needle with the aid of anesthesia booster.Methods A total of 306 patients who met the inclusion criteria were divided into three groups by drawing lots： group A（102 cases），group B（100 cases） and group C（104 cases）.Group A：before the venous indwelling needle puncture，anesthesia booster was used to perform puncture after local anesthesia at the puncture site;Group B：puncture was performed after wet application of lidocaine 20 min before venous indwelling needle puncture;Group C：intravenous indwelling needle puncture was performed by routine method.And then，heart rate，mean arterial pressure，pain score before and after puncture as well as the success rate of one puncture and the incidence of infusion extravasation during operation were compared between the three groups.Results There was no statistically significant difference in heart rates，mean arterial pressures and pain scores among the three groups before puncture（P>0.05）.After venipuncture with 18 G indwelling needle，the heart rates，mean arterial pressures and pain scores of the three groups were higher than those before venipuncture（P<0.05），and difference of pairwise comparison among the three groups was statistically significant（P<0.05 or 0.01）.Among them，the changes of heart rate，mean arterial pressure and pain after puncture were the smallest in the group A and the largest in the group C.There was statistically significant difference in the success rate of one puncture among the three groups（P<0.01），compared with the group C，the success rate of one puncture in the group A and the group B was higher（P<0.05 or 0.01），the success rate of one puncture in the group A was higher than that of the group B，but difference was not statistically significant（P>0.05）.There was statistically significant difference in the incidence of infusion extravasation among the three groups during operation（P<0.01），and the incidence of infusion extravasation of the group A and the group B was lower than that of the group C（P<0.05 or 0.01），but difference was not statistically significant（P>0.05）.Conclusion Anesthesia booster assist can effectively alleviate the pain of venous indwelling needle puncture，achieve the satisfactory effect of painless puncture，improve the success rate of puncture and reduce the pain of patients.

【Key words】 anesthesia booster;intravenous indwelling needle;venipuncture;pain

為確保手術過程中快速輸血輸液，滿足麻醉要求，保證手術安全，術前常常需要選擇較大型號的靜脈留置針行靜脈穿刺。大型號的靜脈留置針因針管管徑較大，穿刺時刺激患者的皮膚及皮下組織，產(chǎn)生較為明顯的痛感，患者容易出現(xiàn)逃避或抵抗等行為[1～2]。同時，疼痛還會使患者產(chǎn)生一系列的病理生理及應激反應，加重患者術前緊張焦慮[3～4]。有研究顯示在穿刺前20 min 在擬穿刺部位涂抹復方利多卡因軟膏鎮(zhèn)痛可減輕穿刺疼痛[5]，但該方法術前準備時間過長，臨床可操作性不強。為彌……