含漱利多卡因复合小剂量咪达唑仑在肥胖患者无痛胃镜中的应用

Application of oral rinse lidocaine compounded with low-dose midazolam in obese patients underwent painless gastroscopy

摘要:

目的 观察含漱利多卡因复合小剂量咪达唑仑用于肥胖患者无痛胃镜检查的麻醉效果。方法 选取2020年8月－2021年10月该院行无痛胃镜检查的肥胖患者120例作为研究对象，按照随机数表法分为常规组、对照组和观察组，每组40例。常规组采用舒芬太尼和丙泊酚静脉麻醉，对照组采用咪达唑仑、舒芬太尼和丙泊酚静脉麻醉，观察组采用含漱2%利多卡因复合咪达唑仑、舒芬太尼和丙泊酚静脉麻醉。比较3组患者麻醉给药前（T₀）、开始检查时（T₁）、胃镜过咽喉部时（T₂）、检查结束时（T₃）和苏醒时（T₄）的心率（HR）、平均动脉压（MAP）、经皮动脉血氧饱和度（SpO₂）和呼吸频率（RR）变化情况，同时记录3组患者丙泊酚总用量、苏醒时间、麻醉效果及不良反应的发生情况。结果 观察组在胃镜检查过程中各时点的HR、MAP和SpO₂变化均优于常规组和对照组，且与常规组和对照组相比，观察组丙泊酚总用量少，苏醒时间短，麻醉效果好，不良反应发生率低，差异均有统计学意义（P < 0.05）。结论 含漱利多卡因复合小剂量咪达唑仑等静脉麻醉药物的方案，在肥胖患者无痛胃镜检查中具有呼吸抑制轻、血流动力学稳定和麻醉效果好等优点，大大降低了肥胖患者无痛胃镜检查过程中的麻醉风险，为肥胖患者无痛胃镜检查提供了一种安全、有效的麻醉方案，值得临床推广应用。

Abstract:

Objective To investigate the anaesthetic effect of oral lidocaine compounded with low-dose midazolam in obese patients underwent painless gastroscopy.Methods 120 cases of obese patients who underwent painless gastroscopy from August 2020 to October 2021 were enrolled in the study. According to the random number chart method, they were divided into a regular group, a control group and an observation group, with 40 cases in each group. The regular group was anaesthetized with sufentanil and propofol intravenously, the control group was anaesthetized with midazolam, sufentanil and propofol intravenously, and the observation group was anaesthetized with oral gargling of 2% lidocaine compounded with midazolam, sufentanil and propofol intravenously. The changes in heart rate (HR), mean arterial pressure (MAP), percutaneous arterial oxygen saturation (SpO₂), and respiratory rate (RR) before anaesthesia administration (T₀), at the beginning of examination (T₁), at the time of gastroscopy over the pharynx (T₂), at the end of examination (T₃), and at the time of awakening (T₄) were compared among the three groups of patients. Meanwhile, the total propofol dosage, wake-up time, anaesthetic effect and the occurrence of adverse effects were also recorded in the three groups.Results The changes in HR, MAP and SpO₂ in the observation group were better than those in the regular group and control group at all time points during gastroscopy, and compared with the regular group and the control group, the observation group had less total propofol dosage, shorter awakening time, better anaesthesia effect and lower incidence of adverse reactions, which were statistically significant (P < 0.05).Conclusion The scheme of oral lidocaine with low-dose midazolam and other intravenous anaesthetic drugs is shown that it has the advantages of light respiratory depression, stable hemodynamics and better anaesthetic effect in obese patients undergoing painless gastroscopy, which greatly decreases the risk of anaesthesia during painless gastroscopy in obese patients and provides a safe and effective anaesthetic scheme for painless gastroscopy in obese patients. It is worthy to be promoted and applied clinically.