静脉利多卡因复合丙泊酚镇静在超声胃镜检查中的应用

Application of intravenous lidocaine in propofol-based sedation for ultrasonic gastroscopy

目的探索静脉利多卡因复合丙泊酚镇静在超声胃镜检查中的应用效果。方法选取2020年3月-2020年7月在雅安市人民医院行超声胃镜检查的患者62例,采用随机数表法分为丙泊酚+利多卡因组(L组)和丙泊酚+生理盐水组(P组),每组31例。L组镇静前静脉推注利多卡因1.0 mg/kg,然后以1.0 mg/(kg·h)持续泵注,P组以相同方式输注等容量生理盐水。两组患者均给予丙泊酚1.5 mg/kg和舒芬太尼0.1μg/kg,患者改良警觉/镇静评分(MOAA/S)>3分或尝试内镜进镜失败,根据情况每次追加丙泊酚0.5 mg/kg。记录两组患者诱导前(T_(1))、诱导后(T_(2))、胃镜插入时(T_(3))、退镜时(T_(4))的心率(HR)、平均动脉压(MAP)与经皮动脉血氧饱和度(SpO_(2)),记录丙泊酚诱导剂量、追加剂量和总量、完全苏醒时间、并发症发生率和内镜医师满意度。结果两组患者在T_(2)、T_(3)和T_(4)时点的HR较T1时点慢,MAP较T1时点低(P<0.05)。L组各时间点HR、MAP和SpO_(2)与P组比较,差异无统计学意义(P>0.05)。L组丙泊酚诱导剂量[(100.08±14.69)和(118.07±27.35)mg]、追加剂量[(73.54±36.34)和(127.52±92.24)mg]、总量[(166.04±27.17)和(244.30±95.05)mg]及平均用量[(5.86±2.67)和(7.44±1.80)mg/(kg·h)]均明显少于P组(P<0.05)。L组完全苏醒时间明显短于P组[(3.24±1.04)和(4.76±0.99)min](P<0.05)。L组低血压、低氧血症、丙泊酚注射痛和呛咳发生率均明显低于P组,内镜医师满意度明显高于P组(P<0.05)。两组患者心动过缓、咽喉部疼痛和腹痛发生率比较,差异均无统计学意义(P>0.05)。两组患者均无恶心呕吐发生。结论超声胃镜检查中静脉推注利多卡因可有效减少术中丙泊酚用量,缩短患者苏醒时间,降低术中并发症发生率,提高内镜医师满意度。

Objective To explore the efficacy of intravenous lidocaine in propofol-based sedation for ultrasonic gastroscopy.Methods 62 patients scheduled for ultrasonic gastroscopy from March 2020 to July 2020 were divided into 2 groups by using a random number table method,the propofol+lidocaine group(group L)and the propofol+normal saline group(group P),with 31 patients in each group.Patients in group L received a bolus of 1.0 mg/kg lidocaine intravenously before sedation,followed by continuous infusion of 1.0 mg/(kg·h).Whereas the group P received the equal volumes of normal saline in the same way.Patients in 2 groups received propofol 1.5 mg/kg and sufentanil 0.1μg/kg.Patients with modified observer's assessment of alertness/sedation scale(MOAA/S)>3 or failed to try endoscopy,propofol 0.5 mg/kg was added per time.The heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO_(2)),propofol induction dose,additional dose,total dose,complete recovery time,the incidence of complications and endoscopist satisfaction were recorded before induction(T_(1)),after induction(T_(2)),gastroscopy insertion(T_(3))and withdrawal(T_(4)).Results Compared with T_(1),HR,MAP in T_(2),T_(3)and T_(4)both decreased in 2 groups(P<0.05).Compared with group P,there were no significant difference in HR,MAP and SpO_(2) at each time point in group L(P>0.05).The induction dose[(100.08±14.69)and(118.07±27.35)mg],additional dose[(73.54±36.34)and(127.52±92.24)mg],total dose of propofol[(166.04±27.17)and(244.30±95.05)mg]and average propofol consumption[(5.86±2.67)and(7.44±1.80)mg/(kg·h)]in group L were significantly lower than those in group P(P<0.05).The complete recovery time in group L was significantly shorter than that in group P[(3.24±1.04)and(4.76±0.99)min](P<0.05).In group L,the incidence of hypotension,hypoxemia,propofol injection pain,choking cough were significantly lower than those in group P,and the endoscopist satisfaction was higher(P<0.05).There were no significant difference in the incidence of bradycardia,sore throat and abdominal pain in two groups(P>0.05).No nausea and vomiting occurred in 2 groups.Conclusion Intravenous lidocaine can decrease propofol requirements and adverse effect during ultrasonic gastroscopy with faster recovery and higher endoscopist satisfaction.