2021 年第 6 期 第 16 卷

含服利多卡因对丙泊酚抑制胃镜插入反应半数有效量的影响

Effect of topical pharyngeal anesthesia with lidocaine on the median effective dose of propofol for inhibiting response to gastroscope insertion

作者：陶星刘缚鲲陶文军万磊薛富善

英文作者：Tao Xing Liu Fukun Tao Wenjun Wan Lei Xue Fushan

单位：首都医科大学附属北京友谊医院麻醉科100050

英文单位：Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：胃镜插入反应；胃镜检查；利多卡因；丙泊酚；半数有效量

英文关键词：Responsetogastroscopeinsertion;Gastroscopy;Lidocaine;Propofol;Medianeffectivedose

• 摘要：

• 目的 观察无痛胃镜检查时含服利多卡因对丙泊酚抑制胃镜插入反应半数有效量（ED50）的影响。方法 本研究为前瞻性随机对照试验，选取2019年12月至2020年1月于首都医科大学附属北京友谊医院消化内镜中心门诊行无痛胃镜检查的患者48例，患者美国麻醉医师协会分级Ⅰ～Ⅱ级。采用随机数字表法分为含服利多卡因组（22例）和不含服利多卡因组（26例）。2组第1例患者的丙泊酚初始剂量均为1.6 mg/kg，后续患者的丙泊酚初始用量依据序贯给药原则由前一例患者的胃镜插入反应确定。丙泊酚抑制胃镜插入反应的ED50采用Probit回归量效曲线计算得出。比较2组患者胃镜检查时间、丙泊酚总用量、胃镜插入反应、丙泊酚镇静抑制胃镜插入反应的ED50及麻醉前、胃镜进镜时、进镜后2 min、检查结束时的平均动脉压、心率、脉搏血氧饱和度(SpO2)变化。结果 所有患者均顺利完成本研究及胃镜检查。含服利多卡因组吞咽反射发生比例高于不含服利多卡因组，差异有统计学意义(P<0.05)，但2组均为轻度吞咽反射不影响操作。含服利多卡因组丙泊酚镇静抑制胃镜插入反应的ED50低于不含服利多卡因组［（1.78±0.07）mg/kg比（1.89±0.12）mg/kg］，差异有统计学意义（P<0.05）。2组麻醉前、胃镜进镜时、进镜后2 min、检查结束时的平均动脉压、心率、SpO2差异均无统计学意义（均P>0.05）。结论 含服利多卡因可降低丙泊酚抑制胃镜插入反应的ED50。

• Objective To observe the effect of topical pharyngeal anesthesia with lidocaine on the median effective dose(ED50) of propofol for inhibiting response to gastroscope insertion(RGI). Methods This was a prospective randomized controlled trial. From December 2019 to January 2020, 48 patients who underwent painless gastroscopy in the Outpatient of Digestive Endoscopy Center, Beijing Friendship Hospital, Capital Medical University were selected. They were classified as grade Ⅰ-Ⅱ by American Society of Anesthesiologists. They were randomly divided into buccal lidocaine group(22 cases) and non-lidocaine group(26 cases). The initial dose of propofol in the first patient of the two groups was 1.6 mg/kg, and the initial dose of propofol in the subsequent patients was determined by the RGI of the previous patient according to the principle of sequential administration. The ED50 of propofol in inhibiting RGI was calculated by Probit regression dose effect curve. The gastroscopy examination time, total dose of propofol, RGI, ED50 of propofol sedation inhibiting RGI, and the changes of mean arterial pressure, heart rate and pulse oxygen saturation(SpO2) before anesthesia, during gastroscopy entering, 2 min after gastroscopy entering and at the end of examination were compared between the two groups. Results All patients successfully completed the study and gastroscopy. The incidence of swallowing in buccal lidocaine group was higher than that in non-lidocaine group(P<0.05), but the swallowing reflex was mild in both groups, which did not affect the operation. ED50 of propofol sedation in buccal lidocaine group was lower than that in non-lidocaine group［（1.78±0.07）mg/kg vs （1.89±0.12）mg/kg］(P<0.05). There were no significant differences in mean arterial pressure, heart rate and SpO2 before anesthesia, during gastroscopy entering, 2 min after gastroscopy entering and at the end of examination between the two groups(all P>0.05). Conclusion Topical pharyngeal anesthesia with buccal lidocaine can reduce ED50 of propofol for inhibiting RGI.