摘要
目的探索老年患者胃镜检查镇静时瑞马唑仑半数有效剂量(ED50)和95%有效剂量(ED95),观察麻醉期间的不良反应。方法选择2020年7至11月海南医学院第二附属医院行胃镜检查老年患者39例,其中男18例,女21例,年龄65~82(72±5)岁,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。顺序静脉注射舒芬太尼0.1μg/kg及试验剂量瑞马唑仑,瑞马唑仑起始剂量为0.17 mg/kg,依据改良Dixon序贯法确定下1例患者的剂量,若前1例患者胃镜检查时有阳性反应,即胃镜置入咽腔时或者置入后2 min内患者出现呛咳、恶心呕吐和(或)体动反应,则下1例患者增加剂量;反之,则降低剂量;瑞马唑仑剂量增减梯度为0.01 mg/kg,直到出现12次折返后停止试验。同时观察麻醉期间不良反应发生情况。结果39例老年患者均完成试验,其中有效21例,无效18例。老年患者胃镜检查镇静时,单次静脉注射瑞马唑仑的ED50为0.153 mg/kg(95%CI:0.151~0.154 mg/kg),ED95为0.164 mg/kg(95%CI:0.160~0.166 mg/kg)。瑞马唑仑用药总剂量为(10.6±2.8)mg,苏醒时间为(10.0±3.4)min,复苏室停留时间为(8.2±2.6)min。麻醉期间发生恶心呕吐1例、一过性低血压4例,未见其他不良反应。结论瑞马唑仑在老年患者胃镜检查镇静时的ED50为0.153 mg/kg,ED95为0.162 mg/kg;不良反应发生率低。
Objective To explore the 50%effective dose(ED50)and 95%effective dose(ED95)of Remimazolam during gastroscopic sedation in elderly patients,and to observe the adverse reactions during anesthesia.Methods From July to November 2020,39 elderly patients,of which there were 18 males and 21 females,aged from 65 to 82(72±5)years,were examined by gastroscopy in the Second Affiliated Hospital of Hainan Medical University,who American Society of Anesthesiologists(ASA)was gradeⅠorⅡ.Sufentanil 0.1μg/kg and test dose Remimazolam were injected intravenously,and the initial dose of Remimazolam was 0.17 mg/kg.The dose of the next patient was determined according to the modified Dixon sequential method.If the former patient had a positive reaction during gastroscopy,such as cough,nausea,vomiting and/or body movement reaction occurred when the gastroscope was placed into the pharynx or in the 2 min,the next patient would increase the dose,otherwise,the dose would be reduced.The dose increase and decrease gradient of Remimazolam was 0.01 mg/kg,and the test was stopped after 12 times of return.At the same time,the occurrence of adverse reactions during anesthesia was observed.Results A total of 39 elderly patients completed the trial,of which 21 were effective and 18 were ineffective.When the elderly patients were sedated by gastroscopy,the ED50 of single intravenous injection of Remimazolam was 0.153 mg/kg(95%CI:0.151-0.154 mg/kg)and the ED95 was 0.164 mg/kg(95%CI:0.160-0.166 mg/kg).The total dose of Remimazolam was(10.6±2.8)mg,the recovery time was(10.0±3.4)min,and the stay time in resuscitation room was(8.2±2.6)min.During anesthesia,nausea and vomiting occurred in 1 case,transient hypotension in 4 cases,and no other adverse reactions were found.Conclusion The ED50 of Remimazolam during gastroscopic sedation in elderly patients is 0.153 mg/kg,ED95 is 0.162 mg/kg,and the incidence of adverse reactions is low.
作者
孙虎
王涛
徐志新
陈晓芳
曹江北
李皓
Sun Hu;Wang Tao;Xu Zhixin;Chen Xiaofang;Cao Jiangbei;Li Hao(Department of Anesthesiology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Anesthesia and Operation Center,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2022年第5期332-335,共4页
National Medical Journal of China
基金
国家重点研发计划重点专项(2018YFC2001900)
海南省卫生计生行业科研项目(20A200217)。
