利多卡因表面麻醉复合静脉麻醉在老年患者无痛胃镜检查中的应用

Application of lidocaine topical anesthesia combined with intravenous anesthesia in painless gastroscopy in elderly patients

目的观察利多卡因表面麻醉复合静脉麻醉在老年患者无痛胃镜检查中的安全性和可行性。方法选择,选择2018年9月至2019年12月本院本院门诊行无痛胃镜检查的老年患者189例,随机分成3组:1%丙泊酚100 mg配依托咪酯20mg混合液,容量比1∶1,0.15~0.2 m L/kg+地佐辛组0.05 mg/kg(A组)、利多卡因表面麻醉+1%丙泊酚100 mg配依托咪酯20 mg混合液,容量比1∶1,0.15~0.2 m L/kg组(B组)、1%丙泊酚100 mg配依托咪酯20 mg混合液,容量比1∶1,0.15~0.2 m L/kg组(C组),各63例,根据镇静深度单次予以混合液1~2 m L。观察并记录3组患者胃镜插入前、插入即刻、插入后的平均动脉压、心率、血氧饱和度,胃镜插入后有无呛咳、体动、呃逆及胃镜检查时间、丙泊酚依托咪酯用量、苏醒时间。结果 A组在胃镜插入后不同时点的平均动脉压、心率、血氧饱和度低于C组,但B组显著低于A、C组,差异具有统计学意义(P<0.05);A组在胃镜插入时的发生体动、呛咳、呃逆低于C组,但B组显著低于A、C组,差异具有统计学意义(P<0.05);C组在胃镜检查时间、丙泊酚依托咪酯用量、苏醒时间明显高于A、B组,差异具有统计学意义(P<0.05)。结论利多卡因表面麻醉复合静脉麻醉在老年患者尤其是心脑血管疾病患者的无痛胃镜中,能减少体动、呛咳、呃逆的发生,维持血流动力学的稳定,降低丙泊酚、依托咪酯用量,缩短胃镜检查时间和苏醒时间,提高患者的安全性及舒适性,也利于疾病的诊断和治疗。

Objective To observe the safety and feasibility of lidocaine topical anesthesia combined with intravenous anesthesia in painless gastroscopy in elderly patients. Methods 189 elderly patients who underwent painless gastroscopy in our outpatient department from September 2018 to December 2019 were selected. They were randomly divided into three groups: 1% propofol 100 mg with etomidate 20 mg mixture, volume ratio 1∶1, 0.15-0.2 mL/kg+dizosin group 0.05 mg/kg(group A), lidocaine topical anesthesia + 1% propofol 100 mg with etomidate 20 mg mixture, volume ratio 1:1, 0.15-0.2 mL/kg(group B), propofol + etomidate 100 mg with etomidate 20 mg mixture(group B), propofol100 mg with etomidate 20 mg mixture volume ratio was 1:1, 0.15-0.2 mL/kg(group C), with 63 cases in each group. The mixture was given 1-2 mLonce according to the depth of sedation. The mean arterial pressure, heart rate and oxygen saturation before, immediately and after gastroscopy insertion were observed and recorded. Cough, physical activity, hiccup and gastroscopy examination time, dosage of etomidate propofol and recovery time were observed and recorded after gastroscopy insertion. Results The mean arterial pressure, heart rate and oxygen saturation of group A at different time points after endoscopy insertion were lower than those of group C, but group B was significantly lower than those of group A and C(P<0.05). The occurrence of motility,cough and hiccup in group A was lower than that of group C, but group B was significantly lower than that of group A and C(P<0.05). The duration of gastroscopy, dosage of etomidate propofol and waking time in group C were significantly higher than those in groups A and B, with statistically significant difference(P<0.05). Conclusion Lidocaine topical anesthesia combined with intravenous anesthesia in elderly patients, especially those with cardiovascular and cerebrovascular diseases, can reduce the occurrence of body movement, cough and hiccup, maintain the stability of hemodynamics, reduce the dosage of propofol and etomidate, shorten the time of gastroscopy examination and recovery, improve the safety and comfort of patients, and is also conducive to the diagnosis of diseases treatment.