瑞马唑仑复合瑞芬太尼用于无痛胃镜检查术的效果

Efficacy of remimazolam combined with remifentanil used for painless gastroscopy

目的:评价瑞马唑仑复合瑞芬太尼用于无痛胃镜检查术的效果。方法:选择行无痛胃镜检查术患者150例,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,BMI 18~30 kg/m^(2),采用随机数字表法分为3组(n=50):丙泊酚复合瑞芬太尼组(P组)、瑞马唑仑0.3 mg/kg复合瑞芬太尼组(R1组)和瑞马唑仑12 mg复合瑞芬太尼组(R2组)。按体重给药以理想体重计算。静脉注射瑞芬太尼0.25μg/kg,然后P组静脉注射丙泊酚1.5 mg/kg,R1组静脉注射瑞马唑仑0.3 mg/kg,R2组静脉注射瑞马唑仑12 mg。改良警觉/镇静评分(MOAA/S评分)≤3分时即开始胃镜操作。给予丙泊酚或瑞马唑仑3 min时若MOAA/S评分仍≥4分,则为镇静失败。术中发生体动反应时,P组静脉注射丙泊酚初始剂量的1/4,R1组静脉注射瑞马唑仑初始剂量的1/4,R2组静脉注射瑞马唑仑2.5 mg,维持MOAA/S评分≤3分。15 min内追加超过3次仍不能维持足够的镇静,则为镇静失败。记录镇静成功情况。记录胃镜检查时间、苏醒时间和离院时间。记录术中体动反应、心动过缓、低血压、呼吸抑制、呃逆、呛咳和注射痛的发生情况。结果:与P组比较,R1组镇静成功率差异无统计学意义(P>0.05),术中体动反应、心动过缓、低血压、呼吸抑制、呛咳和注射痛发生率降低,R2组镇静成功率降低,术中心动过缓、低血压、呼吸抑制和注射痛发生率降低,呃逆发生率升高(P<0.05);与R2组比较,R1组镇静成功率升高,术中体动反应、呛咳和呃逆发生率降低(P<0.05)。结论:瑞马唑仑0.3 mg/kg复合瑞芬太尼可安全有效地用于无痛胃镜检查术。

Objective To evaluate the effect of remimazolam combined with remifentanil used for painless gastroscopy.Methods A total of 150 patients of American Society of Anesthesiologists physical statusⅠorⅡ,aged 18-64 yr,with body mass index of 18-30 kg/m^(2),scheduled for elective painless gastroscopy,were divided into 3 groups(n=50 each)using a random number table method:propofol combined with remifentanil group(group P),remimazolam 0.3 mg/kg combined with remifentanil group(group R1)and remimazolam 12 mg combined with remifentanil group(group R2).Drugs were administrated according to body weight,and calculation was carried out according to ideal body weight.Remifentanil 0.25μg/kg was injected intravenously,propofol 1.5 mg/kg was then injected intravenously in group P,remimazolam 0.3 mg/kg was injected intravenously in group R1,and remimazolam 12 mg was injected intravenously in group R2.When Modified Observer′s Assessment/Alertness and Sedation(MOAA/S)score was≤3,gastroscopy was performed.It was defined as sedation failure when MOAA/S score was still≥4 at 3 min after administration of propofol or remimazolam.When intraoperative body movement occurred,1/4 of the initial dose of propofol was injected intravenously in group P,1/4 of the initial dose of remimazolam was injected intravenously in group R1,and remimazolam^(2).5 mg was injected intravenously in group R2 to maintain MOAA/S score≤3.It was defined as sedation failure when sufficient sedation was not maintained after the additional drugs were given more than 3 times within 15 min.The success of sedation,time for gastroscopy,emergence time and discharge time were recorded.The occurrence of intraoperative body movement,bradyeardia,hypotension,respiratory depression,hiccup,coughing and injection pain was recorded.Results Compared with group P,no significant change was found in the success rate of sedation(P>0.05),and the incidence of intraoperative body movement,bradyeardia,hypotension,respiratory depression,hiccup,coughing and injection pain was decreased in group R1,and the success rate of sedation was significantly decreased,the incidence of intraoperative body movement,bradyeardia,hypotension,respiratory depression,coughing and injection pain was decreased,and the incidence of hiccup was increased in group R2(P<0.05).Compared with group R2,the success rate of sedation was significantly increased,and the incidence of intraoperative body movement,coughing and hiccup was decreased in group R1(P<0.05).Conclusion Remimazolam 0.3 mg/kg combined with remifentanil can be safely and effectively used for painless gastroscopy.