小剂量利多卡因静脉持续输注在无痛肠镜检查中的应用

目的探索小剂量利多卡因静脉持续输注在无痛肠镜检查中的应用效果及不良反应。方法选择行无痛肠镜检查患者150例,随机分为三组,每组50例。S组先静注1%的利多卡因1.5 mg/kg后,按丙泊酚2 mg/kg诱导,待患者睫毛反射消失后,给予2 mg/(kg·h)利多卡因泵注至检查结束;L组以同样的方法诱导,给予4 mg/(kg·h)利多卡因泵注至检查结束;对照组C组以生理盐水替代利多卡因。分别于入室时(T0)、睫毛反射消失时(T1)、过脾曲时(T2)、过肝曲时(T3)和检查结束时(T4)记录各组的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2),记录术中的不良事件、镜检时间、苏醒时间、离院时间、丙泊酚用量及不同时间点的视觉模拟评分(VAS)、苏醒质量评分(OAA/S)。结果三组患者行肠镜检查时T1~T4时的MAP均明显低于T0(P<0.05);组内与T0相比,C组T1、T3、T4时及S、L组T4时HR均明显降低(P<0.05);组内与T1相比,C组T3时HR明显降低(P<0.05)。与C组相比,S组、L组的注射痛、体动反应的发生率明显降低(P<0.05),S组、L组的丙泊酚用量、苏醒时间、苏醒5 min及10 min时的术后镇痛评分明显降低(P<0.05),L组苏醒5 min时术后镇痛评分要低于S组(P<0.05)。结论丙泊酚复合小剂量利多卡因持续输注在无痛肠镜检查中能减少丙泊酚用量,降低了不良反应的发生率,维持患者循环稳定,并且还能减少患者苏醒时间和术后疼痛,因此可安全、有效的应用在无痛肠镜检查中。

Application of continuous intravenous infusion of low-dose lidocaine in painless colonoscopy

【Objective】To explore the effect and side effects of continuous intravenous infusion of low dose lidocaine in painless enteroscopy.【Methods】One hundred and fifty patients who were planned to undergo painless colonoscopy examination were enrolled,and randomly divided into 3 groups,50 cases per group.In group S,1%lidocaine was injected stently at 1.5 mg/kg and then induced by propofol at 2 mg/kg.After the eyelashes disappeared,2 mg/(kg·h)lidocaine was injected until the end of the examination.The L group was induced by the same method and given 4 mg/(kg·h)lidocaine pumping until the end of the examination.Control group C was treated with normal saline instead of lidocaine.Mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)of each group were respectively recorded at entering the room(T0),eyelash reflex disappears(T1),splenic flexure(T2),hepatic flexure(T3)and at the end of the inspection(T4).Adverse events in the examination,microscopic examination time,recovery time,time of departure from the hospital,the dosage of propofol,visual analogue scale(VAS)score and observer's assessment of alertness/sedation(OAA/S)scale score at different time points were recorded.【Results】MAP at T1-T4 was significantly lower than that at T0 in the three groups during colonoscopy(P<0.05).Compared with T0,HR decreased significantly in group C at T1,T3 and T4,and in group S and L at T4(P<0.05).Compared with T1,HR in group C decreased significantly at T3(P<0.05).Compared with group C,the incidence of injection pain and somatic reaction in group S and L was significantly lower(P<0.05),the dosage of propofol,the time of awakening,the postoperative analgesia score at 5 minutes and 10 minutes after waking up in group S and L were significantly lower(P<0.05),and the postoperative analgesia score at 5 minutes after waking up in group L was lower than that of group S(P<0.05).【Conclusion】Continuous infusion of propofol combined with lowdose lidocaine in painless colonoscopy can reduce the dosage of propofol,reduce the incidence of adverse reactions,maintain stable circulation in patients,and reduce the time of patients'resuscitation and postoperative pain.Therefore,it can be safely and effectively applied in painless colonoscopy.