儿科患者在结肠镜检查手术中静脉注射利多卡因可减少丙泊酚的静脉用量:一项随机对照研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：张中伟 编辑：张中伟 审校：曹莹
丙泊酚作为麻醉过程中的镇静药物在内镜手术中被广泛使用，但有时会引起循环系统的并发症。静脉注射利多卡因可减轻丙泊酚输注时的疼痛，减少丙泊酚用量。本研究的目的是评估静脉注射利多卡因在儿科结肠镜检查手术中对减少丙泊酚用量这一作用的有效性和安全性。
40名接受结肠镜检查的儿科患者被随机分为两组。利多卡因组静脉给予盐酸利多卡因(1.5mg/kg静脉注射诱导，2mg/kg/h术中维持)，对照组在接受等剂量利多卡因静脉注射诱导后给予等量生理盐水术中维持。以丙泊酚初始血浆浓度5μg/mL为目标，在脑电双频指数达到55后进行手术。主要观察指标是两组患者中丙泊酚的需要量。
利多卡因组儿科患者的丙泊酚需要量相比对照组减少了35.5%(128.6±30.4mg vs. 199.4±57.6mg；p < 0.00195%,CI:100.60，41.02)。相比对照组，利多卡因组儿科患者的不自主肢体运动的发生率显著降低(p = 0.028，OR = 0.1795%,CI:0.03，0.92)。利多卡因组儿科患者的苏醒时间(p < 0.00195%,CI:7.67，5.13)和恢复时间(p < 0.00195%,CI:7.45，4.35)相比对照组显著降低。利多卡因组儿科患者在手术后30分钟和60分钟的疼痛程度相比对照组明显减轻(0[0–4] vs. 3[0–5]，p < 0.001;0[0–2] vs. 1[0–3]，p = 0.001)。两组之间儿科患者的心动过缓、低血压或缺氧的发生率没有明显差异。
在儿科患者的结肠镜检查术中，静脉注射利多卡因可减少丙泊酚的使用量，提供了更好的术中镇静和术后镇痛效果，并缩短了患者的恢复时间。
Wenshui Yao, Longxin Zhang , Guolin Lu, et al. Use of intravenous lidocaine for dose reduction of propofol in paediatric colonoscopy patients:a randomised placebo-controlled study.[J]. BMC Anesthesiol (2021) 21:299:1
Use of intravenous lidocaine for dose
reduction of propofol in paediatric colonoscopy
patients: a randomised placebo-controlled
Study
Abstract
Background: Propofol, a widely used sedative in endoscopic procedures, sometimes causes cardiopulmonary complications. Intravenous lidocaine can diminish visceral pain and decrease the dose of propofol. The purpose of this study was to assess the efficacy and safety of intravenous lidocaine in reducing propofol dosage during paediatric colonoscopy.
Method:Forty children who underwent colonoscopy were divided into two groups. Lidocaine hydrochloride (1.5 mg/kg induction and 2 mg/kg/h maintenance) was given intravenously to the lidocaine group, and the same amount of saline was given to the control group after they received lidocaine induction. Propofol initial plasma concentration of 5 μg/mL was targeted, and the procedure was performed after the bispectral index value reached 55.The primary outcome was propofol requirement.
Results:The propofol requirement in the lidocaine group was decreased by 35.5% (128.6 ± 30.4 mg vs. 199.4 ± 57.6 mg; p < 0.001; 95%CI: − 100.60, − 41.02). The incidence of involuntary body movements was significantly lower in the lidocaine group (p = 0.028; OR = 0.17; 95%CI: 0.03, 0.92). The awakening time (p < 0.001; 95%CI: − 7.67, − 5.13) and recovery times (p < 0.001; 95%CI: − 7.45, − 4.35) were significantly lower in the lidocaine group. Pain was significantly less at 30 min and 60 min after the procedure in the lidocaine group (0 [0–4] vs. 3 [0–5], p < 0. 001; 0 [0–2] vs. 1 [0–3], p = 0.001). There was no difference in the incidence of bradycardia, hypotension, or hypoxia between the two groups.
Conclusion:For colonoscopy procedures in paediatric patients, intravenous lidocaine reduces the amount of propofol needed, provides better sedation and postprocedural pain management, as well as a reduction in recovery time.
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