静脉输注利多卡因在无痛结肠镜检查中的临床应用

Clinical application of intravenous lidocaine in painless colonoscopy

摘要:

目的 观察静脉输注利多卡因在无痛结肠镜检查中的临床效果，探讨其有效性和安全性。方法 选择在该院接受无痛结肠镜检查的患者90例，采用随机数字表法分为3组：舒芬太尼复合丙泊酚组（S组）、利多卡因复合丙泊酚组（L组）和单纯丙泊酚组（P组），每组30例。采用双盲法分别给予每组患者相应药物，持续监测并记录给药前（T₀）、睫毛反射消失时（T₁）、过脾曲时（T₂）、过肝曲时（T₃）以及镜检完成时（T₄）的心率（HR）、平均动脉压（MAP）和脉搏血氧饱和度（SpO₂），观察3组患者术中丙泊酚预给量、追加量、总用量、不良事件发生情况和术后恢复情况等。结果 与T₀时点相比，3组患者T₁～T₄时点MAP、HR均明显降低（P < 0.05），与T₁时点相比，P组T₂～T₄时点MAP、HR明显升高（P < 0.05），3组SpO₂差异无统计学意义（P > 0.05）；S组和L组丙泊酚预给量、追加量和总用量均明显少于P组（P < 0.05）；L组苏醒时间明显短于S组和P组（P < 0.05）；术后腹部疼痛视觉模拟评分（VAS）和虚弱VAS评分L组明显优于S组或P组（P < 0.05）；L组注射痛、恶心呕吐、低氧血症发生率明显优于S组或P组（P < 0.05），3组患者术中高血压、低血压、心动过缓发生率差异无统计学意义（P > 0.05）。结论 静脉输注利多卡因应用于无痛结肠镜检查中，可有效降低丙泊酚用量、稳定血流动力学、减少不良反应发生，加快术后恢复。

Abstract:

Objective To observe the clinical effect of intravenous lidocaine in painless colonoscopy and investigate its efficacy and safety.Methods 90 patients who underwent painless colonoscopy were selected and divided into 3 groups by random number table method: Sufentanil combined propofol group (group S), lidocaine combined propofol group (group L) and Propofol only group (group P), with 30 patients in each group. The corresponding drugs were given to each group by double-blind method, and the changes of HR, MAP and SpO₂ were continuously monitored and recorded on pre-operation (T₀), loss of eyelash reflex (T₁)，splenic curvature (T₂), liver curvature (T₃) and post-enteroscopy (T₄), the induced dose, additional dose and total amount of propofol during the operation, the occurrence of adverse events such as cardiopulmonary and postoperative recovery in the three groups of patients were also recorded.Result Compared with T₀, MAP and HR at T₁～T₄ in the three groups was significantly reduced (P < 0.05), compared with T₁, MAP and HR of group P at T₂～T₄ was significantly increased (P < 0.05), and there was no significant statistical difference in SpO₂ among the three groups; Propofol predosage, additional dosage and total dosage in group S and group L were significantly lower than those in group P (P < 0.05); The recovery time of group L was significantly shorter than that of group S and group P (P < 0.05); The incidence of injection pain, nausea and vomiting and hypoxemia in group L was significantly higher than that in group S or group P (P < 0.05), and there was no statistically significant difference in the incidence of intraoperative hypertension, hypotension and bradycardia among the three groups.Conclusion Intravenous infusion of lidocaine in painless colonoscopy can effectively reduce the amount of propofol, stabilize hemodynamics, reduce the occurrence of adverse reactions and accelerate postoperative recovery.