甲苯磺酸瑞马唑仑联合右美托咪定应用于ERCP胆道支架植入术老年患者的效果观察

Clinical effect of remazolam toluenesulfonate combined with dexmedetomidine in elderly patients undergoing ERCP biliary stent implantation

目的观察甲苯磺酸瑞马唑仑联合右美托咪定用于经内镜逆行胰胆管造影(ERCP)胆道支架植入术老年患者的麻醉效果。方法选择行ERCP胆道支架植入术老年患者72例,随机分为观察组(甲苯磺酸瑞马唑仑联合右美托咪定)和对照组(丙泊酚联合右美托咪定),每组36例。记录患者入室左侧卧位即刻(T_(0)),诱导成功即刻(T_(1)),放置支架即刻(T_(2)),退镜结束即刻(T_(3))的心率(HR)、血氧(SpO_(2))、平均动脉压(MAP)。记录手术时间、麻醉诱导时间、苏醒时间、术中血管活性药物使用情况,以及入镜呛咳、体动、呼吸抑制、低血压、术后恶心呕吐等不良反应发生情况。采用简易智能量表(MMSE)评估两组术后认知功能情况。结果与对照组比较,观察组T_(1)~T_(3)时HR明显增快,MAP明显升高,T_(1)时SpO_(2)明显升高,麻醉起效时间快、苏醒时间明显缩短(P<0.01或0.05)。两组患者苏醒10 min时MMSE评分与术前比较明显降低,观察组的认知功能优于对照组(P<0.01)。两组手术时间以及呼吸抑制、低血压、呛咳、体动、恶心呕吐发生率差异无统计学意义(P>0.05)。结论甲苯磺酸瑞马唑仑联合右美托咪定应用于ERCP胆道支架植入术老年患者安全有效,术中循环稳定,患者术后苏醒和意识认知功能恢复快。

Objective To investigate the anesthetic effects and postoperative cognitive function of Remazolam toluene sulfonate combined with dexmedetomidine and propofol combined with dexmedetomide in elderly patients undergoing ERCP biliary stent implantation.Method Seventy-two elderly patients undergoing ERCP biliary stent implantation were enrolled in the selection phase.The patients were randomly divided into two groups:remimazolam tosilate combined with dexmedetomidine group(group A,observation group)and propofol combined with dexmedetomidine group(group B,control group),with 36 cases in each group.HR,MAP,SpO_(2) were recorded immediately after entering the left lateral position(T_(0)),immediately after induction(T_(1)),immediately after stent placement(T_(2)),and immediately after the end of withdrawal(T_(3)).The operation time,anesthesia induction time,the use of vasoactive drugs during operation,the emergence time,the occurrence of adverse reactions such as cough,body movement,respiratory depression,hypotension,postoperative nausea and vomiting,and the time to leave the recovery room after operation were recorded.The Mini-Mental State Examination(MMSE)was used to evaluate the postoperative cognitive function of the two groups.Results Compared with the control group,HR,MAP and SpO_(2) in the observation group were significantly increased from T_(1) to T_(3),and the onset time of anesthesia was faster and the recovery time was significantly shortened(P<0.01 or 0.05).The MMSE score of the two groups was significantly lower at 10 min after recovery than that before surgery,and the cognitive function of the observation group was better than that of the control group(P<0.01).There was no significant difference in operation time and incidence of respiratory depression,hypotension,cough,body movement,nausea and vomiting between the two groups(P>0.05).Conclusion Remimazolam tosilate combined with dexmedetomidine is safe and effective in elderly patients undergoing ERCP biliary stent implantation,with stable circulation during operation and rapid recovery of consciousness and cognitive function after operation.