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| 利多卡因对老年患者胃肠镜检查中呼吸抑制和低血压的影响 |
| Effect of lidocaine on respiratory depression and hypotension in elderly patients undergoing gastroenteroscopy |
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| DOI：10.12089/jca.2025.07.007 |
| 中文关键词: 利多卡因 丙泊酚 老年 胃肠镜检查 呼吸抑制 低血压 |
| 英文关键词: Lidocaine Propofol Aged Gastroenteroscopy Respiratory depression Hypotension |
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| 中文摘要: |
目的：探讨利多卡因复合丙泊酚静脉麻醉对老年患者胃肠镜检查中呼吸抑制和低血压的影响。
方法：选择2024年4—6月行无痛胃肠镜检查老年患者112例，男56例，女56例，年龄65~80岁，BMI 18.5~30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：利多卡因组（L组）和生理盐水组（N组），每组56例。患者入室后开放静脉通路，完成心电监护测量基础值后分组给药：L组依次给予舒芬太尼0.1 μg/kg、利多卡因1.5 mg/kg、丙泊酚1.0 mg/kg；N组依次给予舒芬太尼0.1 μg/kg、与利多卡因等容量的生理盐水、丙泊酚1.0 mg/kg。两组均在检查过程中按需追加丙泊酚。记录胃镜和肠镜检查中呼吸抑制、低血压和不自主体动的发生情况。记录丙泊酚胃镜置入用量、维持用量和总用量。记录检查结束后15 min VAS疼痛评分、VAS疲劳评分和清醒时间。记录消化内科医师满意度评分和患者满意度评分。记录麻醉诱导时注射痛、术中过敏反应、苏醒后舌头麻木、金属味、耳鸣、恶心、呕吐、头晕和头痛等不良事件的发生情况。
结果：在胃镜检查中，与N组比较，L组术中呼吸抑制和低血压发生率明显降低（P<0.05）；在肠镜检查中，两组术中呼吸抑制、低血压和不自主体动发生率差异无统计学意义；在胃肠镜检查中，与N组比较，L组术中呼吸抑制、低血压和不自主体动发生率明显降低（P<0.05）。与N组比较，L组丙泊酚胃镜置入用量、维持用量和总用量明显减少，检查结束后15 min VAS疲劳评分明显降低，清醒时间明显缩短，消化内科医师满意度评分明显升高（P<0.05）。两组检查结束后15 min VAS疼痛评分、患者满意度评分和不良事件发生率差异无统计学意义。
结论：利多卡因复合丙泊酚静脉麻醉可减少老年患者胃肠镜检查中呼吸抑制和低血压的发生，提高胃肠镜检查的安全性。 |
| 英文摘要: |
Objective: To investigate the effect of lidocaine combined with propofol intravenous anesthesia on the incidence of respiratory depression and hypotension in elderly patients undergoing gastroenteroscopy.
Methods: A total of 112 patients undergoing painless gastroenteroscopy from April to June 2024, 56 males and 56 females, aged 65-80 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, were divided into two groups by the random number table method: lidocaine group (group L) and normal saline group (group N), 56 patients in each group. Intravenous access was opened after entering the examination room, and the medication was administered after the basic values of ECG monitoring were measured. Group L was given sufentanil 0.1 μg/kg, lidocaine 1.5 mg/kg, propofol 1.0 mg/kg, and then propofol was added as needed during the examination. Group N was given sufentanil 0.1 μg/kg, normal saline equal to lidocaine, propofol 1.0 mg/kg, and then propofol was added as needed during the examination. The occurrence of adverse reactions such as respiratory depression, hypotension, and immobility were recorded during gastroscopy and colonoscopy. The dosage for gastroscopy insertion, maintenance dosage, and total dosage of propofol were recorded. VAS pain score and fatigue score 15 minutes after the examination and waking time were recorded. Gastroenterologist's satisfaction score and patient's satisfaction score were recorded. The occurrence of adverse events such as injection pain during induction, intraoperative allergic reaction, numbness of tongue, metallic taste, tinnitus, nausea, vomiting, dizziness, and headache after recovery were recorded.
Results: The incidences of intraoperative respiratory depression and hypotension during gastroscopy in group L were significantly lower than those in group N (P < 0.05). There was no statistically significant difference in the incidence of intraoperative respiratory depression, hypotension and involuntary body movement during colonoscopy between the two groups. During the total process of gastroscopy and colonoscopy, compared with group N, the incidence of intraoperative respiratory depression, hypotension, and involuntary body movement in group L was significantly lower (P < 0.05). Compared with group N, the dosage for gastroscopy insertion, maintenance dose and total dose of propofol were decreased, the postoperative VAS fatigue score was reduced, the waking time was shortened, and the gastroenterologist's satisfaction score was increased significantly in group L (P < 0.05). There was no statistically significant difference in the VAS pain score 15 minutes after the examination, patient's satisfaction score, and the incidence of adverse events between the two groups.
Conclusion: Lidocaine combined with propofol intravenous anesthesia can reduce the occurrence of respiratory depression and hypotension during gastroscopy and colonoscopy in elderly patients, and improve the safety of gastroenteroscopy. |
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