环泊酚复合利多卡因在老年肥胖患者无痛肠镜中的麻醉效果与安全性

Anesthetic effect and safety of cyclopol combined with lidocaine in painless colonoscopy for elderly obese patients

摘要:

目的 探讨环泊酚复合利多卡因在老年肥胖患者无痛肠镜中的麻醉效果与安全性。方法 选取2022年6月—2023年6月在西湖大学医学院附属杭州市第一人民医院接受无痛肠镜检查的老年肥胖患者92例，通过分层随机抽样法分为实验组（环泊酚复合利多卡因组）和对照组（单纯环泊酚组），每组46例。实验组患者接受环泊酚0.3 mg/kg+ 2%利多卡因1.5 mg/kg，对照组患者仅接受环泊酚0.3 mg/kg。比较两组患者麻醉效果（胃肠镜检查、麻醉诱导、苏醒、定向力恢复等时间），比较两组患者麻醉前5 min（T₀）、诱导后（T₁）、置入胃镜后即刻（T₂）、操作结束时（T₃）、离开恢复室前（T₄）心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO₂）的变化，比较两组患者评分状况［术后Ramsay镇静评分、VAS评分、苏醒质量评分（OAA/S）、内镜医师和患者满意度、离院评分（改良Aldrete评分）］和不良反应（恶心呕吐、体动反应、低血压、肠痉挛、呼吸抑制、呛咳呃逆）。结果 两组患者胃肠镜检查时间、麻醉诱导时间比较，差异均无统计学意义（P >0.05）。实验组苏醒时间、定向力恢复时间均短于对照组（P <0.05）。两组患者T₀、T₁、T₂、T₃、T₄时HR、MAP、SpO₂比较，结果 ①不同时间点HR、MAP和SpO₂比较，差异均有统计学意义（P <0.05）；②两组患者HR、MAP和SpO₂比较，差异均无统计学意义（P >0.05）；③两组患者HR、MAP和SpO₂变化趋势比较，差异均无统计学意义（P >0.05）。两组患者Ramsay评分、OAA/S评分和离院评分比较，差异均无统计学意义（P >0.05）。实验组VAS评分低于对照组，内镜医师和患者满意度评分高于对照组（P <0.05）。实验组体动反应、低血压、呼吸抑制、呛咳呃逆发生率均低于对照组（P <0.05）。两组恶心呕吐、肠痉挛发生率比较，差异无统计学意义（P >0.05）。结论 环泊酚复合利多卡因在老年肥胖患者进行无痛肠镜检查中，相比单纯环泊酚麻醉，不仅能显著改善麻醉效果，缩短恢复时间，还能提高患者与医师的满意度，降低不良反应发生率，是一种更为安全有效的麻醉方案。

Abstract:

Objective To evaluate the anesthetic effect and safety of cyclopol combined with lidocaine in painless colonoscopy for elderly obese patients.Methods Ninety-two elderly obese patients who underwent painless colonoscopy from June 2022 to June 2023 at Hangzhou First People's Hospital Affiliated to West Lake University School of Medicine were selected. They were divided into the experimental group (cyclopol combined with lidocaine group) and the control group (cyclopol alone group) through stratified random sampling, with 46 cases in each group. The experimental group received 0.3 mg/kg of cyclopol and 2% lidocaine at a dose of 1.5 mg/kg, while the control group received only 0.3 mg/kg of cyclopol. The two groups were compared in terms of anesthetic effects (duration of colonoscopy procedure, duration of anesthesia induction, time to recovery, and time to orientation recovery), changes in heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SpO₂) 5 minutes before anesthesia (T₀), after anesthesia induction (T₁), immediately after colonoscopy insertion (T₂), at the end of the operation (T₃), and before leaving the recovery room (T₄), postoperative Ramsay sedation scores, VAS scores, Observer Assessment of Alertness/Sedation Scale (OAA/S) scores, endoscopist and patient satisfaction scores, discharge scores (modified Aldrete scores), and the occurrence of adverse reactions (nausea and vomiting, body movement, hypotension, intestinal spasm, respiratory depression, choking and hiccup).Results There was no significant difference between the two groups in the duration of colonoscopy procedure and that of anesthesia induction (P > 0.05). The experimental group had shorter times to recovery and orientation recovery compared with the control group (P < 0.05). Comparison of HR, MAP and SpO₂ at T₀, T₁, T₂, T₃ and T₄ demonstrated that they were different among the time points (F = 18.630, 27.143 and 13.491, all P < 0.05) but not between the groups (F = 0.556, 1.725 and 0.862, all P > 0.05), and that the change trends of these indicators were not different between the groups (F = 0.546, 0.713 and 0.441, all P > 0.05). There was no significant difference between the two groups in Ramsay sedation scores, OAA/S scores, and discharge scores (P > 0.05). However, the experimental group had a lower VAS score and higher satisfaction scores from endoscopists and patients compared with the control group (P < 0.05). The incidence of body movement, hypotension, respiratory depression, choking and hiccup in the experimental group was lower than in the control group (P < 0.05). No difference was observed in the incidence of nausea and vomiting or intestinal spasm between the two groups (P >0.05)Conclusions Cyclopol combined with lidocaine in elderly obese patients undergoing painless colonoscopy, compared with cyclopol anesthesia alone, can not only significantly improve anesthetic effects and shorten the time to recovery but also increase both patient and physician satisfaction while reducing the incidence of adverse reactions, making it a safer and more effective anesthesia option.