摘要
目的:探究瑞马唑仑联合瑞芬太尼在肥胖患者无痛胃镜检查中的安全性和有效性。方法:选取拟行无痛胃镜检查的肥胖患者60例,采用摸球法,随机分为瑞马唑仑组(n=30例)和丙泊酚组(n=30例)。所有患者静脉注射瑞芬太尼20μg后,瑞马唑仑组静脉泵注瑞马唑仑18 mg·kg^(-1)·h^(-1),丙泊酚组静脉泵注丙泊酚120 mg·kg^(-1)·h^(-1),当改良警觉/镇静量表(Modified Observer’s Assessment of Alertness and Sedation,MOAA/S)评分≤1时停止泵注,开始胃镜检查。胃镜检查结束后,瑞马唑仑组静脉注射拮抗药氟马西尼0.2 mg(2 mL),丙泊酚组注射生理盐水2 mL。记录2组患者心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、脉搏氧饱和度(pulse oxygen saturation,SpO_(2))、托下颌时长、苏醒时长、运动能力恢复时长,以及胃镜检查过程中的低氧血症、低血压、注射痛和体动等不良事件。结果:与丙泊酚组相比,瑞马唑仑组呼吸抑制率明显降低(P<0.05)、托下颌时长、苏醒时长和运动能力恢复时长明显缩短(P<0.05)。丙泊酚组进镜至咽喉部时的HR和MAP及进镜至十二指肠时的HR均显著高于瑞马唑仑组(P<0.05)。瑞马唑仑组低氧血症、低血压、注射痛和疲劳发生率显著低于丙泊酚组(P<0.05)。结论:瑞马唑仑联合瑞芬太尼可作为肥胖患者无痛胃镜检查的一种安全且有效的麻醉方案。
OBJECTIVE To investigate the safety and efficacy of remimazolam combined with remifentanil used in obese patients undergoing painless gastroscopy.METHODS Totally 60 obese patients undergoing painless gastroscopy were randomly divided into remimazolam group(n=30)and propofol group(n=30)by using ball-touching method.All the patients were given intravenous remifentanil 20μg as the basic analgesia,and then 18 mg·kg^(-1)·h^(-1) remimazolam and 120 mg·kg^(-1)·h^(-1) propofol were injected intravenously in remimazolam group and propofol group,respectively.When the Modified Observer’s Assessment of Alertness and Sedation(MOAA/S)scale was less than or equal to 1,the trace syringe pump was stopped and gastroscopy was initiated.At the end of gastroscopy,flumazenil 0.2 mg(2 mL)was injected intravenously in remimazolam group,and 2 mL normal saline was injected in propofol group.Heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2)),and the time of jaw-lift,recovery,and motor ability recovery were observed in the two groups.Hypoxemia,hypotension,injection pain,body movement and other adverse reactions in the two groups were also recorded.RESULTS Compared with propofol group,the rate of respiratory depression was significantly decreased in remimazolam group(P<0.05),and the time of jaw-lift,the recovery time and motor ability recovery time were significantly shortened in remimazolam group(P<0.05).Compared with remimazolam group,propofol group had significantly faster HR and higher MAP when the gastroscope reached throat,and faster HR when the gastroscope reached duodenum(P<0.05).The incidences of hypoxemia,hypotension,injection pain and fatigue in remimazolam group were significantly lower than those in propofol group(P<0.05).CONCLUSION Remimazolam combined with remifentanil could be used as a safe and effective anesthesia strategy in obese patients undergoing painless gastroscopy.
作者
闫丽娟
王霄
YAN Lijuan;WANG Xiao(Department of Anesthesiology,The First Affiliated Hospital of Xiamen University,Fujian Xiamen 361003,China;Department of Ultrasound,The First Affiliated Hospital of Xiamen University,Fujian Xiamen 361003,China;School of Clinical Medicine,Fujian Medical University,Fujian Fuzhou 350122,China)
出处
《中国医院药学杂志》
CAS
北大核心
2023年第21期2429-2432,共4页
Chinese Journal of Hospital Pharmacy
基金
厦门市自然科学基金项目(编号:3502Z20227345)
福建中医药大学校管临床专项资助(编号:XB2022184)。
