口腔含漱利多卡因复合丙泊酚用于肥胖患者行无痛胃镜检查的效果及安全性
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摘要
目的:探究口腔含漱利多卡因复合丙泊酚用于肥胖患者行无痛胃镜检查的效果及安全性。方法:选取2017年1月-2018年7月就诊于本院拟行无痛胃镜检查的肥胖患者96例。按照随机数字表法将其分为对照组和试验组,各48例。对照组给予常规丙泊酚静注麻醉,试验组给予利多卡因口腔含漱后行丙泊酚静注麻醉,比较两组围检查期指标(检查时间、丙泊酚用量、苏醒时间)、麻醉效果、血氧饱和度(SpO2)、平均动脉压(MAP)和不良反应发生情况。结果:两组胃镜检查时间比较差异无统计学意义(P>0.05),试验组丙泊酚使用量和苏醒时间均显著低于对照组,比较差异均有统计学意义(P<0.05);试验组的麻醉效果优于对照组(Z=-2.119,P=0.034);麻醉前,两组SpO2和MAP水平比较差异均无统计学意义(P>0.05);检查时,两组SpO2和MAP水平均低于麻醉前,但试验组均高于对照组,比较差异均有统计学意义(P<0.05);苏醒时,两组SpO2和MAP水平均高于检查时,但两组比较差异均无统计学意义(P>0.05);试验组不良反应发生率为22.92%,显著低于对照组的62.50%(P<0.05)。结论:在肥胖患者行无痛胃镜检查中应用口腔含漱利多卡因复合丙泊酚麻醉能显著减少丙泊酚用量,增加麻醉效果,降低麻醉对呼吸和循环系统的影响,安全性更好。
Objective:To explore the efficacy and safety of oral rinsing Lidocaine combined with Propofol for painless gastroscopy in obese patients.Method:A total of 96 obese patients who were going to undergo painless gastroscopy in our hospital from January 2017 to July 2018 were selected.According to the random number table method,they were divided into control group and experimental group,48 cases in each group.The control group was given routine Propofol intravenous anesthesia,and experimental group received oral rinsing Lidocaine combined with Propofol intravenous anesthesia.The peri-examination indexes(examination time,Propofol dosage,recovery time),anesthesia effect,blood oxygen saturation(SpO2),mean arterial pressure(MAP) and adverse reactions were compared between two groups.Result:The examination time in two groups was compared,the difference was not statistically significant(P>0.05),the Propofol dosage and recovery time in experimental group were significantly lower than those of control group,the differences were statistically significant(P<0.05).The anesthesia effect of experimental group was better than that of control group(Z=-2.119,P=0.034).Before anesthesia,the levels of SpO2 and MAP in two groups were compared,the differences were not statistically significant(P>0.05),when checking,the levels of SpO2 and MAP in two groups were lower than those of before anesthesia,but the experimental group were higher than those of control group,the differences were statistically significant(P<0.05),when awake,the levels of SpO2 and MAP in two groups were higher than those of when checking,but the two groups were compared,the differences were not statistically significant(P>0.05).The incidence of adverse reactions in experimental group was 22.92%,which was significantly lower than 62.50% of control group(P<0.05).Conclusion:The application of oral rinsing Lidocaine combined with Propofol anesthesia in obese patients undergoing painless gastroscopy can significantly reduce the dosage of propofol,increase anesthesia effect,reduce the influence of anesthesia on respiratory and circulatory system,and has better safety.
Objective:To explore the efficacy and safety of oral rinsing Lidocaine combined with Propofol for painless gastroscopy in obese patients.Method:A total of 96 obese patients who were going to undergo painless gastroscopy in our hospital from January 2017 to July 2018 were selected.According to the random number table method,they were divided into control group and experimental group,48 cases in each group.The control group was given routine Propofol intravenous anesthesia,and experimental group received oral rinsing Lidocaine combined with Propofol intravenous anesthesia.The peri-examination indexes(examination time,Propofol dosage,recovery time),anesthesia effect,blood oxygen saturation(SpO2),mean arterial pressure(MAP) and adverse reactions were compared between two groups.Result:The examination time in two groups was compared,the difference was not statistically significant(P>0.05),the Propofol dosage and recovery time in experimental group were significantly lower than those of control group,the differences were statistically significant(P<0.05).The anesthesia effect of experimental group was better than that of control group(Z=-2.119,P=0.034).Before anesthesia,the levels of SpO2 and MAP in two groups were compared,the differences were not statistically significant(P>0.05),when checking,the levels of SpO2 and MAP in two groups were lower than those of before anesthesia,but the experimental group were higher than those of control group,the differences were statistically significant(P<0.05),when awake,the levels of SpO2 and MAP in two groups were higher than those of when checking,but the two groups were compared,the differences were not statistically significant(P>0.05).The incidence of adverse reactions in experimental group was 22.92%,which was significantly lower than 62.50% of control group(P<0.05).Conclusion:The application of oral rinsing Lidocaine combined with Propofol anesthesia in obese patients undergoing painless gastroscopy can significantly reduce the dosage of propofol,increase anesthesia effect,reduce the influence of anesthesia on respiratory and circulatory system,and has better safety.
引文
[1]夏江燕,陆新健,袁静,等.丙泊酚复合阿片类药物在胃镜检查中的应用[J].临床麻醉学杂志,2016,32(5):464-467.
[2] Das S,Al-Mashani A,Suri N,et al.Combination of Continuous Dexmedetomidine Infusion with Titrated Ultra-Low-Dose Propofol-Fentanyl for an Awake Craniotomy[J].Sultan Qaboos Univ Med J,2016,16(3):e347-351.
[3]易艳萍,彭雪梅.肥胖患者腹腔镜手术中麻醉用药的研究进展[J].广东医学,2015,36(1):141-144.
[4]徐广民,范丹,李鹏,等.口腔含漱利多卡因在肥胖患者行无痛胃镜检查中的应用[J].四川医学,2017,38(4):421-424.
[5]姜华,郭玉娜.利多卡因胶浆表面麻醉复合小剂量丙泊酚在老年无痛胃镜检查中的应用[J].首都医科大学学报,2014,35(1):28-31.
[6] Carabotti M,Avallone M,Cereatti F,et al.Usefulness of Upper Gastrointestinal Symptoms as a Driver to Prescribe Gastroscopy in Obese Patients Candidate to Bariatric Surgery.A Prospective Study[J].Obes Surg,2016,26(5):1075-1080.
[7]杜良刚,谢鸿昌.肥胖患者无痛胃镜检查按校正体重给药的可行性[J].中国内镜杂志,2015,21(9):1003-1005.
[8]赵艾华,申军梅,张兵慧,等.肥胖因素对异丙酚镇静效力的影响[J].中华麻醉学杂志,2015,35(11):1368-1369.
[9]朱小兵,吴论,刘志群.肥胖患者全身麻醉诱导期按去脂肪体重与按体重维库溴铵用药的药效学比较[J].实用医学杂志,2015,31(3):417-419.
[10]周一,章云飞,孔岚,等.肥胖因素对患者异丙酚靶控输注性能的影响[J].中华麻醉学杂志,2015,35(1):121-122.
[11]梅莉,赵国栋.右美托咪定复合丙泊酚用于老年患者胃镜检查术麻醉的效果[J].中华麻醉学杂志,2013,33(6):680-682.
[12]任杰,杨帆,刘丽莉.舒芬太尼复合丙泊酚在无痛胃镜治疗中的应用及护理[J].实用药物与临床,2013,16(1):79-81.
[13]廖武豪,邹启荣,蒋德英,等.不同麻醉诱导剂量丙泊酚对病态肥胖患者心脏泵功能的影响[J].实用医学杂志,2017,33(24):4145-4148.
[14]金娅梦,朱凌音,陈湧鸣.无痛胃镜检查对不同体重患者呼吸循环功能的影响及护理对策[J].实用医学杂志,2015,31(23):3955-3956.
[15]李强,胡华琨,沈世晖,等.盐酸达克罗宁胶浆含服复合利多卡因咽喉部喷雾在患儿食管扩张术中的麻醉效果[J].临床麻醉学杂志,2018,34(5):459-462.
[16]吴富生,穆清华,何丽萍,等.安定及间苯三酚注射液联合利多卡因胶浆在胃镜中应用[J].中国地方病防治杂志,2014,29(S2):221-222.
[17]姜华,郭玉娜.利多卡因胶浆表面麻醉复合小剂量丙泊酚在老年无痛胃镜检查中的应用[J].首都医科大学学报,2014,35(1):28-31.
[18]窦晓坛,汤爱荣,刘风,等.复方利多卡因乳膏涂抹内镜减轻胃镜检查反应的临床研究[J].中华消化内镜杂志,2018,35(6):437-438.
[19]王振静,孟宪慧.小剂量舒芬太尼复合丙泊酚在无痛胃镜检查中的镇静效果及安全性[J].中华老年医学杂志,2015,34(8):884-886.
[20]朱姝,陈志勇,朱美华.不同剂量丙泊酚对无痛胃镜检查患者苏醒质量的影响[J].临床麻醉学杂志,2016,32(7):705-706.
[2] Das S,Al-Mashani A,Suri N,et al.Combination of Continuous Dexmedetomidine Infusion with Titrated Ultra-Low-Dose Propofol-Fentanyl for an Awake Craniotomy[J].Sultan Qaboos Univ Med J,2016,16(3):e347-351.
[3]易艳萍,彭雪梅.肥胖患者腹腔镜手术中麻醉用药的研究进展[J].广东医学,2015,36(1):141-144.
[4]徐广民,范丹,李鹏,等.口腔含漱利多卡因在肥胖患者行无痛胃镜检查中的应用[J].四川医学,2017,38(4):421-424.
[5]姜华,郭玉娜.利多卡因胶浆表面麻醉复合小剂量丙泊酚在老年无痛胃镜检查中的应用[J].首都医科大学学报,2014,35(1):28-31.
[6] Carabotti M,Avallone M,Cereatti F,et al.Usefulness of Upper Gastrointestinal Symptoms as a Driver to Prescribe Gastroscopy in Obese Patients Candidate to Bariatric Surgery.A Prospective Study[J].Obes Surg,2016,26(5):1075-1080.
[7]杜良刚,谢鸿昌.肥胖患者无痛胃镜检查按校正体重给药的可行性[J].中国内镜杂志,2015,21(9):1003-1005.
[8]赵艾华,申军梅,张兵慧,等.肥胖因素对异丙酚镇静效力的影响[J].中华麻醉学杂志,2015,35(11):1368-1369.
[9]朱小兵,吴论,刘志群.肥胖患者全身麻醉诱导期按去脂肪体重与按体重维库溴铵用药的药效学比较[J].实用医学杂志,2015,31(3):417-419.
[10]周一,章云飞,孔岚,等.肥胖因素对患者异丙酚靶控输注性能的影响[J].中华麻醉学杂志,2015,35(1):121-122.
[11]梅莉,赵国栋.右美托咪定复合丙泊酚用于老年患者胃镜检查术麻醉的效果[J].中华麻醉学杂志,2013,33(6):680-682.
[12]任杰,杨帆,刘丽莉.舒芬太尼复合丙泊酚在无痛胃镜治疗中的应用及护理[J].实用药物与临床,2013,16(1):79-81.
[13]廖武豪,邹启荣,蒋德英,等.不同麻醉诱导剂量丙泊酚对病态肥胖患者心脏泵功能的影响[J].实用医学杂志,2017,33(24):4145-4148.
[14]金娅梦,朱凌音,陈湧鸣.无痛胃镜检查对不同体重患者呼吸循环功能的影响及护理对策[J].实用医学杂志,2015,31(23):3955-3956.
[15]李强,胡华琨,沈世晖,等.盐酸达克罗宁胶浆含服复合利多卡因咽喉部喷雾在患儿食管扩张术中的麻醉效果[J].临床麻醉学杂志,2018,34(5):459-462.
[16]吴富生,穆清华,何丽萍,等.安定及间苯三酚注射液联合利多卡因胶浆在胃镜中应用[J].中国地方病防治杂志,2014,29(S2):221-222.
[17]姜华,郭玉娜.利多卡因胶浆表面麻醉复合小剂量丙泊酚在老年无痛胃镜检查中的应用[J].首都医科大学学报,2014,35(1):28-31.
[18]窦晓坛,汤爱荣,刘风,等.复方利多卡因乳膏涂抹内镜减轻胃镜检查反应的临床研究[J].中华消化内镜杂志,2018,35(6):437-438.
[19]王振静,孟宪慧.小剂量舒芬太尼复合丙泊酚在无痛胃镜检查中的镇静效果及安全性[J].中华老年医学杂志,2015,34(8):884-886.
[20]朱姝,陈志勇,朱美华.不同剂量丙泊酚对无痛胃镜检查患者苏醒质量的影响[J].临床麻醉学杂志,2016,32(7):705-706.