利多卡因在无痛结肠镜检查中的效果观察

Observation of the effects of lidocaine in painless colonoscopy

目的探讨利多卡因在无痛结肠镜检查中对丙泊酚用量及恢复质量的影响。方法选取2018年7月—2019年10月于徐州医科大学附属医院行纤维结肠镜检查的患者,共100例。根据检查过程中是否使用利多卡因,将上述患者分为观察组(L组)和空白组(C组)。C组患者的诱导药物为瑞芬太尼20μg、丙泊酚1.0~2.5mg/kg。检查过程中,丙泊酚初始浓度调整为5 mg·kg^-1·h^-1,当患者有体动反应时,静脉追加20~50 mg丙泊酚直至患者体动消失,并且将丙泊酚的浓度增加1 mg·kg^-1·h^-1。L组患者在诱导前静脉推注2%利多卡因(1.5 mg/kg),1 min内推注完毕,给予利多卡因2 mg·kg^-1·h^-1泵注至检查结束。其余麻醉诱导以及麻醉维持过程同C组患者相同。比较2组患者的一般情况;丙泊酚诱导量、丙泊酚总量、体动次数;苏醒时间,苏醒即刻、苏醒后5 min、10 min疼痛VAS评分,停药后5 min、10 min时的警觉与镇静评分(OAA/S),离院时间;比较2组患者不良反应发生率。结果与C组比较,L组患者检查所需的丙泊酚用量减少,苏醒快而完全,腹痛程度减轻,离院时间缩短,注射痛发生率降低,差异有统计学意义(P<0.05或P<0.01)。呼吸抑制、低血压及术中知晓发生率2组比较,差异无统计学意义(P>0.05)。结论结肠镜检查前,静脉推注1.5 mg/kg 2%利多卡因,并在检查过程中按照2 mg·kg^-1·h^-1泵注,能够减少丙泊酚的用量、减轻患者疼痛,改善苏醒后的恢复质量。

Objective To explore the effects of lidocaine on the dosage of propofol and recovery quality during painless colonoscopy.Methods A total of 100 patients undergoing painless colonoscopy in the Affiliated Hospital of Xuzhou Medical University from July 2018 to October 2019 were enrolled.According to the use of lidocaine,the patients were divided into two groups:an observation group(group L)and a blank group(group C).The induction drugs used in group C were remifentanil 20μg and propofol 1.0-2.5 mg/kg.During the examination,an initial concentration of propofol was adjusted to 5 mg·kg^-1·h^-1.When body movement appeared,20-50 mg propofol was intravenously given until body movement disappeared,and the concentration of propofol increased by 1 mg·kg^-1·h^-1.Before induction,patients in group L were intravenously infused with 2%lidocaine(1.5 mg/kg)over 1 min,followed by 2 mg·kg^-1·h^-1lidocaine via a pump until the end of examination.Other anesthesia induction and maintenance procedures were the same as those in group C.Then,the two groups were compared for general information,the induction and total dose of propofol and the number of body movements;the time of recovery,the Visual Analogue Scale(VAS)score immediately after recovery,5 min after recovery,and 10 min after recovery,and the Observer’s Assessment of Alertness/Sedation Scale(OAA/S)scores 5 min and 10 min after withdrawal,and the time of discharge;and adverse reaction rates.Results Compared with group C,patients in group L required decreased doses of propofol for examination,presented relieved abdominal pain,with faster and improved recovery,shortened discharge time,and a reduced incidence of injection pain(P<0.05 or P<0.01).There was no significant difference in the rates of respiratory depression,hypotension,and intraoperative awareness between the two groups(P>0.05).Conclusions Intravenous infusion of 1.5 mg/kg 2%lidocaine followed by pumping of 2 mg·kg^-1·h^-1 lidocaine during the examination,can reduce the dosage of propofol,relieve the pain of patients,and improve the recovery quality.