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

摘要:

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0.1 μg/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（T₁）、诱导后（T₂）、胃镜插入时（T₃）、退镜时（T₄）的心率（HR）、平均动脉压（MAP）与经皮动脉血氧饱和度（SpO₂），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T₂、T₃和T₄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SpO₂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。

Abstract:

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 0.1 μg/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 (SpO₂), propofol induction dose, additional dose, total dose, complete recovery time, the incidence of complications and endoscopist satisfaction were recorded before induction (T₁), after induction (T₂), gastroscopy insertion (T₃) and withdrawal (T₄).Results Compared with T₁, HR, MAP in T₂, T₃ and T₄ both decreased in 2 groups (P < 0.05) . Compared with group P, there were no significant difference in HR, MAP and SpO₂ 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.