实用老年医学

实用老年医学 ›› 2024, Vol. 38 ›› Issue (3): 265-269.doi: 10.3969/j.issn.1003-9198.2024.03.012

• 临床研究 • 上一篇    下一篇

利多卡因气雾剂在老年病人无痛胃镜诊疗中的应用

刘向荣, 宋少波, 柳胜安, 李慧, 陈国胜   

  1. 210028 江苏省南京市,南京中医药大学附属中西医结合医院麻醉科(刘向荣,柳胜安);消化科(李慧);311202 浙江省杭州市,萧山医院麻醉科(宋少波);210029 江苏省南京市,南京医科大学第一附属医院胰腺中心(陈国胜)
  • 收稿日期:2023-04-21 出版日期:2024-03-20 发布日期:2024-03-26
  • 通讯作者: 陈国胜,Email:djlvcgs@sina.com
  • 基金资助:
    江苏省科学技术厅社会发展面上项目(BE2022817)

Application of lidocaine aerosol in painless gastroscopy in elderly patients

LIU Xiangrong, SONG Shaobo, LIU Sheng'an, LI Hui, CHEN Guosheng   

  1. Department of Anesthesiology(LIU Xiangrong, LIU Sheng'an); Department of Gastroenterology(LI Hui),Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine, Nanjing 210028, China; Department of Anesthesiology, Xiaoshan Hospital, Hangzhou 311201, China(SONG Shaobo); Pancreas Center,the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029,China(CHEN Guosheng)
  • Received:2023-04-21 Online:2024-03-20 Published:2024-03-26
  • Contact: CHEN Guosheng, Email:djlvcgs@sina.com

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摘要： 目的 观察利多卡因气雾剂在老年病人无痛胃镜诊疗中的安全性和有效性。 方法 选择2022年6—12月我院内镜中心行无痛胃镜诊疗的年龄>65岁、美国麻醉医师学会分级Ⅰ～Ⅲ级的老年病人100例。按照随机数表法分成A、B组(n=50),A组先采用利多卡因气雾剂咽喉部喷雾表面麻醉,然后采用瑞芬太尼+丙泊酚组合静脉麻醉;B组直接采用瑞芬太尼+丙泊酚组合静脉麻醉。记录并比较2组术前基础和术中最低的平均动脉压(MAP)、心率(HR)、SpO2,胃镜成功置入时丙泊酚的用量和丙泊酚总用量,胃镜成功置入时的Ramsay镇静评分,苏醒时间以及术中不良反应的发生情况。 结果 与B组相比,A组胃镜成功置入时丙泊酚的用量和总用量显著减少(P<0.05),术中最低MAP、HR、SpO2显著增高(P<0.05),Ramsay镇静评分和苏醒时间显著减少(P<0.05),术中呛咳体动、呼吸抑制、低血压等不良反应发生率显著降低(P<0.05)。 结论 利多卡因气雾剂能够显著减少丙泊酚的用量,同时呛咳、呼吸抑制、低血压和HR降低等不良反应发生率显著降低,病人苏醒更快,是适合老年病人无痛胃镜诊疗的一种安全有效的麻醉方法。
   

关键词: 利多卡因气雾剂, 老年人, 无痛胃镜

Abstract: Objective To observe the safety and effectiveness of lidocaine aerosol in painless gastroscopy in the elderly patients. Methods A total of 100 patients over 65 years old with American Society of Anesthesiologists classificationⅠ-Ⅲ in our endoscopy center receiving painless gastroscopy from June to December 2022 were divided into two groups (n=50) according to random number table. The patients in group A received lidocaine aerosol sprayed to the surface of throat, followed by intravenous anesthesia with remifentanil and propofol, while the patients in group B were directly intravenously anesthetized with remifentanil and propofol. The preoperative and the lowest intraoperative mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) in the two groups were recorded and compared. The dosage during successful implantation of gastroscope and total amount of propofol, the Ramsay sedation score and recovery time, the incidence of intraoperative adverse reactions, including coughing, motility, respiratory depression (SpO2<90%), hypotension (<30% of the baseline value) and decreased HR (<50 beats/min) were recorded and compared between the two groups. Results Compared with group B, the dosage during successful implantation of gastroscope and total amount of propofol were significantly decreased (P<0.05). The intraoperative minimum MAP, HR and SpO2 were significantly increased (P<0.05), and the Ramsay sedation score and recovery time were significantly decreased (P<0.05). The incidence rates of adverse reactions of coughing, respiratory depression and hypotension were significantly reduced (P<0.05) in group A. Conclusions Lidocaine aerosol can significantly reduce the amount of propofol. At the same time, the adverse reactions of coughing, respiratory depression, hypotension and decreased heart rate are also significantly reduced. Besides, the patients receiving lidocaine aerosol present with a shorter wake-up time. Thus, lidocaine aerosol is a safe and effective anesthesia method suitable for painless gastroscopy in the elderly patients.

Key words: lidocaine aerosol, aged, painless gastroscope

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