静脉输注利多卡因显著降低结肠镜检查患者丙泊酚的用量：一项随机安慰剂对照研究
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Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study
背景与目的
丙泊酚用于结肠镜检查镇静期间可发生心肺相关并发症。静脉注射利多卡因可减轻内脏疼痛，并减少手术期间丙泊酚的用量。 我们假设静脉注射利多卡因可减少结肠镜检查期间丙泊酚的用量并改善患者行结肠镜检查后的恢复效果。
方 法
本研究共纳入40名接受结肠镜检查的患者。在滴注丙泊酚使患者意识不清后，给予静脉注射利多卡因（1.5mg.kg-1，然后4mg.kg-1.h-1维持）或相同体积的生理盐水。标准化镇静并使用丙泊酚和氯胺酮。主要结局指标是丙泊酚的用量。次要结局指标：氧饱和度下降的发生次数、内镜医师的操作条件、到恢复室所需的时间，结肠镜检查后的疼痛及疲劳。
结 果
静脉输注利多卡因可使丙泊酚的用量显著减少：58（47）vs 121（109）mg（P=0.02）。两组氯胺酮的用量相似：利多卡因组和生理盐水组分别为19（2）vs 20（3）mg。两组患者氧饱和度下降的发生次数、内镜医师的操作条件、到恢复室所需的时间相似。利多卡因组患者结肠镜检查后疼痛（P<0.01）和疲劳（P=0.03）显著降低。
结 论
静脉输注利多卡因可使患者结肠镜检查期间丙泊酚用量减少50％。利多卡因也可改善患者结肠镜检查后即刻的疼痛和疲劳。
原始文献摘要
Forster C1, Vanhaudenhuyse A2, Gast P3, Louis E3, Hick G1, Brichant JF1, Joris J4. Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study. Br J Anaesth. 2018 Nov;121(5):1059-1064. doi: 10.1016/j.bja.2018.06.019.
Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reducespropofol requirements during colonoscopy and improves post-colonoscopy recovery.
Methods: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration ofpropofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg-1 then 4 mg kg-1 h-1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists' working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue.
Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists' comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group.
Conclusions: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine.
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