利多卡因气雾剂在老年病人无痛胃镜诊疗中的应用

Application of lidocaine aerosol in painless gastroscopy in elderly patients

目的观察利多卡因气雾剂在老年病人无痛胃镜诊疗中的安全性和有效性。方法选择2022年6—12月我院内镜中心行无痛胃镜诊疗的年龄>65岁、美国麻醉医师学会分级Ⅰ~Ⅲ级的老年病人100例。按照随机数表法分成A、B组(n=50),A组先采用利多卡因气雾剂咽喉部喷雾表面麻醉,然后采用瑞芬太尼+丙泊酚组合静脉麻醉;B组直接采用瑞芬太尼+丙泊酚组合静脉麻醉。记录并比较2组术前基础和术中最低的平均动脉压(MAP)、心率(HR)、SpO_(2),胃镜成功置入时丙泊酚的用量和丙泊酚总用量,胃镜成功置入时的Ramsay镇静评分,苏醒时间以及术中不良反应的发生情况。结果与B组相比,A组胃镜成功置入时丙泊酚的用量和总用量显著减少(P<0.05),术中最低MAP、HR、SpO_(2)显著增高(P<0.05),Ramsay镇静评分和苏醒时间显著减少(P<0.05),术中呛咳体动、呼吸抑制、低血压等不良反应发生率显著降低(P<0.05)。结论利多卡因气雾剂能够显著减少丙泊酚的用量,同时呛咳、呼吸抑制、低血压和HR降低等不良反应发生率显著降低,病人苏醒更快,是适合老年病人无痛胃镜诊疗的一种安全有效的麻醉方法。

Objective To observe the safety and effectiveness of lidocaine aerosol in painless gastroscopy in the elderly patients.Methods A total of 100 patients over 65 years old with American Society of Anesthesiologists classificationⅠ-Ⅲin our endoscopy center receiving painless gastroscopy from June to December 2022 were divided into two groups(n=50)according to random number table.The patients in group A received lidocaine aerosol sprayed to the surface of throat,followed by intravenous anesthesia with remifentanil and propofol,while the patients in group B were directly intravenously anesthetized with remifentanil and propofol.The preoperative and the lowest intraoperative mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO_(2))in the two groups were recorded and compared.The dosage during successful implantation of gastroscope and total amount of propofol,the Ramsay sedation score and recovery time,the incidence of intraoperative adverse reactions,including coughing,motility,respiratory depression(SpO_(2)<90%),hypotension(<30%of the baseline value)and decreased HR(<50 beats/min)were recorded and compared between the two groups.Results Compared with group B,the dosage during successful implantation of gastroscope and total amount of propofol were significantly decreased(P<0.05).The intraoperative minimum MAP,HR and SpO_(2)were significantly increased(P<0.05),and the Ramsay sedation score and recovery time were significantly decreased(P<0.05).The incidence rates of adverse reactions of coughing,respiratory depression and hypotension were significantly reduced(P<0.05)in group A.Conclusions Lidocaine aerosol can significantly reduce the amount of propofol.At the same time,the adverse reactions of coughing,respiratory depression,hypotension and decreased heart rate are also significantly reduced.Besides,the patients receiving lidocaine aerosol present with a shorter wake-up time.Thus,lidocaine aerosol is a safe and effective anesthesia method suitable for painless gastroscopy in the elderly patients.