利多卡因气雾剂在阻塞性睡眠呼吸暂停综合征患者无痛胃镜中的应用  

Application of lidocaine aerosol in painless gastroscopy in patientswith obstructive sleep apnea syndrome

作　　者：刘向荣[1] 宋少波 柳胜安 李慧[3] 许常娥 LIU Xiangrong;SONG Shaobo;LIU Sheng an;LI Hui;XU Chang e(Department of Anesthesiology,Affiliated Hospital of Integrated Traditional and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,Jiangsu,China;Department of Anesthesiology,Xiaoshan Hospital Affiliated to Hangzhou Normal University,Hangzhou 311202,Zhejiang,China;Department of Gastroenterology,Affiliated Hospital of Integrated Traditional and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,Jiangsu,China;Department of Anesthesiology,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210031,Jiangsu,China)

机构地区：[1]南京中医药大学附属中西医结合医院麻醉科,江苏南京210028 [2]杭州师范大学附属萧山医院麻醉科,浙江杭州311202 [3]南京中医药大学附属中西医结合医院消化科,江苏南京210028 [4]南京医科大学第四附属医院麻醉科,江苏南京210031

出　　处：《暨南大学学报（自然科学与医学版）》2023年第4期431-436,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：江苏省科学技术厅社会发展项目(BE2022817)。

摘　　要：目的:探讨利多卡因气雾剂在阻塞性睡眠呼吸暂停综合征(OSAS)患者胃镜检查中的有效性和安全性。方法:选择2022年7月至2022年12月南京中医药大学附属中西医结合医院胃镜中心行无痛胃镜检查的OSAS患者100例,年龄24~60岁,美国麻醉医师学会(ASA)Ⅱ~Ⅲ级,STOP-Bang量表评分≥3分。采用随机数字表法分为A、B两组(n=50),A组先采用利多卡因气雾剂咽喉表面麻醉,然后采用瑞芬太尼+丙泊酚组合静脉麻醉,B组仅采用瑞芬太尼+丙泊酚组合静脉麻醉。记录两组胃镜成功置入时的Ramsay镇静评分、检查过程中的麻醉效果、成功置入胃镜时丙泊酚用量和检查结束后丙泊酚总用量,检查过程中呼吸抑制(SpO2<90%)、呛咳、内镜医生暂停操作的例数。结果:与B组比较,A组胃镜成功置入时的Ramsay镇静评分显著降低,麻醉效果提高,检查过程中呼吸抑制、呛咳、暂停操作的例数及术中丙泊酚总用量显著减少。结论:利多卡因气雾剂能明显降低OSAS患者胃镜检查中丙泊酚的用量,减少静脉麻醉过程中的不良反应尤其是呼吸抑制的发生,提高麻醉效果,明显增加麻醉安全性,尤其适用于OSAS患者的无痛胃镜的麻醉。Objective:To investigate the efficacy and safety of lidocaine aerosol through gastroscopy in patients with obstructive sleep apnea syndrome(OSAS).Methods:A total of 100 OSAS patients aged from 24 to 60 years were enrolled to the study from patients admitted to the gastroscopy center of our hospital from July 2022 to December 2022.Patients with ASA grade ofⅡ~Ⅲand STOP-Bang scale score of≥3 points were arranged for analgesic gastroscopy.Patients were divided into group A and group B through random number table method(n=50).Patients in group A was pretreated with lidocaine aerosol throat surface anesthesia,followed by remifentanil+propofol combined intravenous anesthesia,while group B was treated with remifentanil+propofol combined intravenous anesthesia separately.Ramsay sedation score,anesthetic effect during the examination,dosage of propofol at the time of successful gastroscopy implantation and total dosage of propofol after the examination,number of cases of respiratory depression(SpO 2<90%)during the examination,number of cases of cough during the examination,and number of cases of endoscopist suspending the operation during the examination were recorded as evaluation indicators in the two groups.Results:Compared with group B,Ramsay s sedation score and anesthetic effect were significantly decreased in group A after gastroscopy implantation.Besides,reduced number of cases of respiratory depression during the examination,decreased total dosage of propofol during the examination,reduced number of cases of choking during the examination,and the number of cases of suspension during the examination were observed in patients of group A.Conclusion:Lidocaine aerosol significantly reduces and the adverse reactions in intravenous anesthesia,especially the occurrence of respiratory depression,and the dosage of propofol in OSAS patients which further improves the anesthetic effect and the safety of anesthesia.Thus,lidocaine aerosol is especially suitable for painless gastroscopy anesthesia in OSAS patients.

关 键 词：阻塞性睡眠呼吸暂停综合征 利多卡因气雾剂 无痛胃镜 

分 类 号：R614.2[医药卫生—麻醉学]