摘要
目的探讨静脉给予利多卡因在胃肿瘤患者内窥镜黏膜下剥离术(endoscopic submucosal dissection,ESD)中的临床应用。方法选取2013年6月至2016年4月于我院诊断为早期胃肿瘤患者拟择期行内窥镜黏膜下剥离手术患者104例为本研究试验对象,随机分为A、B两组,每组各52例。A组患者镇静前静脉注射单次剂量1.5mg/kg利多卡因,随后镇静期间以2mg/kg/h速度持续输注利多卡因;B组患者以相同方式接受相同剂量的生理盐水。记录患者ESD期间使用的芬太尼和丙泊酚总量;在镇静诱导前、镇静诱导后及ESD手术后的心率和平均血压;手术后30min、6h及24h的上腹部和喉痛疼痛情况等。结果在ESD手术过程中,A组患者芬太尼的总使用量明显低于B组(97.41±26.26vs 132.16±32.15μg),且组间差异具有统计学意义(P<0.0001)。A组镇静所需时间显著低于B组(38.72±11.02vs 57.56±10.48,P<0.0001)。另外,A组患者喉咙疼痛人数也显著低于B组(28.85%vs 65.38%)。两组患者在并发症方面,包括发烧、白细胞增多、穿孔及肺炎等方面均无统计学差异(P>0.05)。结论静脉注射利多卡因可有效用于辅助镇静内窥镜黏膜下剥离术胃癌患者。
Objective To investigate the clinical application of intravenous lidocaine during endoscopic submucosal dissection(endoscopic submucosal dissection,ESD)for gastric neoplasm.Methods 104 patients diagnosed as early gastric neoplasm and scheduled for ESD from June 2013 to April 2016 in our hospital were chosen in this study,and randomly divided into group A and B with each group 52 patients.Patients in group A received intravenous lidocaine as a bolus dose of 1.5 mg/kg before sedation,followed by a continuous infusion at a rate of 2 mg/kg/h during sedation;Patients in group B received normal saline as a placebo following the same protocol.Total used doses of fentanyl and propofol during ESD,heart rate and mean blood pressure before/after sedation induction and after ESD,epigastric and throat pain score at 30 minutes,6 and 24 hours after ESD were recorded.Results During the ESD procedure,The total used fentanyl dose in group A was lower than that in group B(97.41±26.26 vs 132.16±32.15μg),with the significantly statistic difference(P<0.0001).The needed sedation time in group A was significantly lower than that in group B(38.72±11.02 vs 57.56±10.48,P<0.0001).Moreover,fewer patients in group A complained of throat pain compared to that in group B(28.85%vs 65.38%).No obvious differences for the complications including fever,leukocytosis,perforation and pneumonia existed between two groups(P>0.05).Conclusion Intravenous lidocaine can effectively adjuvantly sedate the patients with gastric neoplasm for endoscopic submucosal dissection.
作者
赵宁
高怀新
ZHAO Ning;GAO Huai-xin(Department of Anesthesiology,Shanxi Nuclear Industy 215 Hospital,Xianyang710005,China)
出处
《中国实验诊断学》
2019年第5期810-814,共5页
Chinese Journal of Laboratory Diagnosis
基金
陕西省重点研发计划(2017SF-039)
关键词
静脉注射
利多卡因
胃癌
内窥镜粘膜下剥离术
intravenous
lidocaine
gastric neoplasm
endoscopic submucosal dissection
