不同剂量瑞马唑仑复合丙泊酚应用于无痛胃镜检查的效果

Effect of different doses of remimazolam combined with propofol in painless gastroscopy

目的比较不同剂量瑞马唑仑复合丙泊酚在无痛胃镜检查中的应用效果。方法选择2020年11—12月拟行无痛胃镜检查的患者160例,男76例,女84例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为四组:丙泊酚2 mg/kg组(C组)、瑞马唑仑0.1 mg/kg复合丙泊酚1 mg/kg组(R1组)、瑞马唑仑0.2 mg/kg复合丙泊酚1 mg/kg组(R2组)和瑞马唑仑0.3 mg/kg复合丙泊酚1 mg/kg组(R3组),每组40例。C组静脉注射丙泊酚2 mg/kg;R1组、R2组和R3组先分别静脉注射瑞马唑仑0.1、0.2和0.3 mg/kg,随后静脉注射丙泊酚1 mg/kg。术中发生呛咳或体动反应时,追加丙泊酚0.5 mg/kg。15 min内追加不超过3次且每次追加间隔时间1 min以上视为镇静成功。记录镇静成功例数、丙泊酚用量、胃镜检查时间、苏醒时间和离院时间。记录术中呛咳、体动、呃逆、心动过缓、低血压、低氧血症等不良反应的发生情况。结果与C组比较,R1组镇静成功率明显降低(P<0.05),术中呛咳、体动发生率明显升高(P<0.05);R1组、R2组和R3组丙泊酚用量明显减少(P<0.05),术中呃逆发生率明显升高(P<0.05),低血压和低氧血症发生率明显降低(P<0.05);R1组和R2组苏醒时间和离院时间明显缩短(P<0.05);R3组苏醒时间和离院时间明显延长(P<0.05)。与R1组比较,R2组和R3组镇静成功率明显升高(P<0.05),丙泊酚用量明显减少(P<0.05),术中呛咳、体动发生率明显降低(P<0.05);R3组苏醒时间和离院时间明显延长(P<0.05)。与R2组比较,R3组苏醒时间和离院时间明显延长(P<0.05)。结论瑞马唑仑0.2 mg/kg复合丙泊酚1 mg/kg镇静成功率高,对呼吸和循环影响小,苏醒时间和离院时间短,可安全有效地用于无痛胃镜检查。

Objective To compare the effect of different doses of remimazolam combined with propofol in painless gastroscopy.Methods A total of 160 patients from November 2020 to December 2020 scheduled for painless gastroscopy,76 males and 84 females,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into four groups using random number table method:propofol 2 mg/kg group(group C),remimazolam 0.1 mg/kg combined with propofol 1 mg/kg group(group R1),remimazolam 0.2 mg/kg combined with propofol 1 mg/kg group(group R2),and remimazolam 0.3 mg/kg combined with propofol 1 mg/kg group(group R3),40 patients in each group.The doses of remimazolam injected in group R1,group R2 and group R3 were 0.1,0.2 and 0.3 mg/kg,respectively,followed by propofol 1 mg/kg intravenously while the dose of propofol injected was 2 mg/kg in group C.Propofol 0.5 mg/kg was added for intraoperative cough or body movement.It was defined as sedation success when no more than 3 times were added within 15 minutes and the interval of each addition was more than 1 minutes.The success rate of sedation,dosages of propofol,the operation time,recovery time and departure time were recorded.The occurrence of cough,body movement,hiccup,bradycardia,hypotension and hypoxemia during operation were recorded.Results Compared with group C,the success rate of sedation were significantly decreased in group R1(P<0.05),and the occurrence of cough,body movement were significantly increased in group R1(P<0.05);the dosage of propofol was significantly decreased in groups R1,R2 and R3(P<0.05),the occurrence of hiccup was significantly increased in groups R1,R2 and R3(P<0.05),and the occurrences of hypotension and hypoxemia were significantly decreased in groups R1,R2 and R3(P<0.05);the recovery time and depature time were significantly shorterned in groups R1 and R2(P<0.05);and the recovery time and depature time were significantly prolonged in group R3(P<0.05).Compared with group R1,the success rate of sedation were significantly increased in groups R2 and R3(P<0.05),the dosage of propofol was significantly decreased in groups R2 and R3(P<0.05),and the occurrence of cough,body movement were significantly decreased in groups R2 and R3(P<0.05);the recovery time and depature time were significantly prolonged in group R3(P<0.05).Compared with group R2,the recovery time and depature time were significantly prolonged in group R3(P<0.05).Conclusion Remimazolam 0.2 mg/kg combined with propofol 1 mg/kg had a high sedation success rate,had small effect on respiration and circulation,and had short recovery time and depature time,so it can be safely and effectively used in painless gastroscopy.