利多卡因气雾剂复合利多卡因及丙泊酚静脉麻醉在无痛胃镜检查中的应用

目的观察利多卡因气雾剂复合利多卡因及丙泊酚静脉麻醉应用在无痛胃镜检查中的安全性和可行性。方法选择2018年6-12月在沈阳市肛肠医院行无痛胃镜检查的20~70岁患者共80例,ASAⅠ~Ⅱ、BMI为18.5~27.9 kg/m^2,随机分为2组,每组40例。A组为芬太尼+丙泊酚组:依次缓慢静注芬太尼0.05 mg,丙泊酚1.5~2 mg/kg;B组为利多卡因气雾剂+利多卡因+丙泊酚组:利多卡因气雾剂喷喉后,依次缓慢静注2%利多卡因注射液1 mg/kg、丙泊酚注射液1.5~2 mg/kg。镜检中如发生呛咳,静注丙泊酚注射液30~50 mg。记录入室时(T 0)、胃镜过咽喉部时(T 1)、苏醒时(T 2)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO 2)、镜检持续时间、麻醉时间、丙泊酚注射液用量、胃镜检中的呛咳发生率。观察术后有无恶心、呕吐发生。结果B组T 1时刻的MAP高于A组(P<0.05);A组胃镜检中的呛咳发生率、丙泊酚注射液用量、术后恶心呕吐发生率高于B组(P<0.05)。结论利多卡因气雾剂表面麻醉复合2%利多卡因注射液1 mg/kg、丙泊酚注射液静脉麻醉应用在胃镜检查中可使血流动力学平稳,丙泊酚注射液用量少,不良反应发生率低。

Application of lidocaine aerosol combined with lidocaine and propofol for intravenous anesthesia in painless gastroscopy

Objective To observe the efficacy and safety of lidocaine aerosol combined with lidocaine and propofol for intravenous anesthesia in painless gastroscopy.Methods Eighty ASAⅠ~Ⅱpatients(BMI 18.5~27.9 kg/m^2,20~70 years old)in Shenyang Intestinal and Anal Hospital undergoing painless gastroscopy from June to December 2018 were enrolled,and they were divided into two groups randomly,forty patients in each group.Patients in group A(fentanyl+propofol group)were given fentanyl(0.05 mg)and propofol(1.5~2 mg/kg)intravenously.Patients in group B(lidocaine aerosol+lidocaine+propofol group)received surface anesthesia with lidocaine aerosol and 2%lidocaine(1 mg/kg)and propofol(1.5~2 mg/kg)for intravenous anesthesia.Another dosage of propofol(30~50 mg)could be used to inhibit cough reflex.The heart rate(HR),oxygen saturation(SpO 2),and mean arterial pressure(MAP)were recorded at room admission(T 0),and at the time of enteroscopy(T 1)and waking up(T 2).The gastroscopy time,anesthesia time,total dosage of the propofol and the incidence of cough reflex were recorded.The incidences of nausea and vomiting were also observed.Results In group B,the levels of MAP at T 1 were higher than those in group A(P<0.05).The incidence of cough reflex,nausea,vomiting and the total dosage of the propofol in group A were higher than those in group B(P<0.05).Conclusion Application of lidocaine aerosol topical anesthesia combined with 2%lidocaine(1 mg/kg)and propofol intravenous anesthesia in painless gastroscopy can stablize the hemodynamics with less dosage of propofol and fewer adverse reactions.