利多卡因联合依托咪酯在老年人无痛胃镜中的应用

Application of lidocaine plus etomidate for elderly painless gastroscopy

目的探讨利多卡因联合依托咪酯在老年人无痛胃镜检查中的应用效果。方法选择150例拟行无痛胃镜检查的老年患者,随机分为3组,利多卡因联合依托咪酯组(LE)、芬太尼联合依托咪酯组(FE)和芬太尼联合丙泊酚组(FP),每组各50例,分别给予相应麻醉药物,待患者睫毛反射消失后停止注射,行胃镜检查术。持续监测并记录两组患者于给药前(T0)、检查开始时(T1)、胃镜过声门时(T2)、术毕时(T3)、苏醒时(T4)的平均动脉压(MAP)、呼吸频率(RR)、心率(HR)和脉搏氧饱和度(SpO2)等生命体征的变化。记录麻醉诱导时间、胃镜检查时间、术后苏醒时间、阿托品和麻黄碱使用情况;记录术中及术后有关并发症的发生情况。结果与FP组相同时间点相比,LE组和FE组T1的MAP、RR和HR,以及T2的RR较高(P<0.05)。与FP组相比,LE组和FE组低血压、呼吸暂停、注射痛发生率及麻黄碱使用率均较低(P<0.05)。与FE组相比,LE组和FP组肌阵挛和恶心呕吐的发生率,LE组嗜睡发生率,FP组头晕发生率均较低(P<0.05)。结论利多卡因复合依托咪酯用于老年人无痛胃镜检查麻醉效果好,不良反应少。

Objective To explore the efficacy and safety of lidocaine combined with etomidate for the elderly painless gastroscopy. Methods Total of 150 patients undergoing painless gastroscopy were randomly and equally allocated into 3 groups（n=50）： LE group（lidocaine combined with etomidate）, FE group（fentanyl combined with etomidate） and FP group（fentanyl combined with propofol）. Gastroscopy was performed after the eyelash reflex disappearing. MAP, RR, HR and SpO2 were monitored and recorded at the time point of before medication（T0）, examination start（T1）, gastroscopy go through glottis（T2）, end of the operation（T3） and the time of recovery（T4）. Recovery time, the anesthesia induction time, gastroscopy time and complications issue were also recorded. Results In group LE and group FE, the MAP, t HR and RR at T1 and the RR at T2 were increased significantly compared with in group FP（P〈0.05）. In group LE and group FE, the hypotension, apnea, injection pain and the use rate of ephedrine were decreased significantly compared with in group FP（P〈0.05）. Compared with group FE, the incidence of myoclonus, nausea and vomiting in group LE and group FP, somnolence in group LE and dizziness in group FP were decreased significantly（P〈0.05）. Conclusion Lidocaine plus etomidate is effective and less adverse reaction for elderly painless gastroscopy.