利多卡因联合依托咪酯在老年人无痛肠镜中的应用

Application of lidocaine combined with etomidate for elderly patients painless colonoscopy

目的：评价利多卡因联合依托咪酯在老年人无痛肠镜检查中的应用效果及安全性。方法选择150例行无痛肠镜检查的老年患者,采用随机数字表法分为3组,每组50例：利多卡因联合依托咪酯组（ LE组）、芬太尼联合依托咪酯组（ FE组）和芬太尼联合丙泊酚组（ FP组）。采用双盲法分别给予相应麻醉药物,待患者睫毛反射消失后停止注射,行肠镜检查术。持续监测并记录两组患者给药前（T0）、检查开始时（T1）、肠镜至回盲瓣时（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、肠镜检查时间、术后苏醒时间、阿托品和麻黄碱使用情况；记录术中呼吸暂停、心动过缓、低氧血症、肌阵挛、注射痛、低血压及术后有关并发症的发生情况。结果与LE组比较,FP组T1时MAP、HR 及 T1~T2时 RR 明显降低[（69．7±11．1） mmHg vs.（88．6±11．2） mmHg；（61．3±10．3）次/min vs.（73．4±7．7）次/min；（8．4±2．6）次/min vs.（17．5±4．1）次/min；（10．1±3．2）次/min vs.（18．0±2．5）次/min,P均〈0．05]；与 FE 组相比,FP 组 T1时 HR、RR 及 T2时 RR 均明显降低[（61．3±10．3）次/min vs.（70．2±9．8）次/min；（8．4±2．6）次/min vs.（16．1±2．4）次/min；（10．1±3．2）次/min vs.（16．6±3．1）次/min,P均〈0．05]。结论利多卡因联合依托咪酯用于老年人无痛肠镜检查麻醉效果满意,不良反应少,值得临床推广。

Objective To assess the efficacy and safety of lidocaine combined with etomidate for the elderly patients undergoing painless colonoscopy. Methods 150 patients undergoing painless colonoscopy were randomly and equally allocated into 3 groups：lidocaine combined with etomidate（group LE,n=50）,fentanyl combined with etomid-ate（group FE,n=50） and fentanyl combined with propofol（group FP,n=50）. The patients received one of the three anesthetic combinations in a double-blind fashion. Colonoscopy was performed after the eyelash reflex disap-peared. MAP,RR,HR and SpO2 were monitored and recorded before the medication（ T0 ） ,at the time point of examina-tion start（T1）,colonoscopy getting to ileocecal valve（T2）,end of operation （T3） and recovery（T4）. Recovery time, the anesthesia induction time,colonoscopy time,the number of cases in which atropine and/or ephedrine were used,the anesthetic efficacy were recorded. In addition, apnea, bradycardia, hypoxemia, myoclonus, injection pain, hypotension and postoperative complications were also recorded. Results Compared with group LE, MAP, HR at T1 and RR at T1 ~T2 of group FP decreased significantly [（69. 7 ± 11. 1）mmHg vs. （88. 6 ± 11. 2）mmHg;（61. 3 ± 10. 3） /min vs. （73. 4 ± 7. 7）/min;（8. 4 ± 2. 6） /min vs. （17. 5 ± 4. 1） /min;（10. 1 ± 3. 2）/min vs. （18. 0 ± 2. 5）/min,P〈0. 05]. However,compared with group FE, HR at T1 and RR in group FP significantly decreased [ （ 61. 3 ± 10. 3 ）/min vs. （70. 2 ± 9. 8）/min;（8. 4 ± 2. 6）/min vs. （16. 1 ± 2. 4）/min;（10. 1 ± 3. 2）/min vs. （16. 6 ± 3. 1）/min,P〈0. 05]. Conclusion Lidocaine combined with etomidate for the elderly painless colonoscopy can be considered more effective with less adverse reactions.