甲苯磺酸瑞马唑仑与丙泊酚用于老年无痛结肠镜检查的有效性及安全性

Efficacy and safety of remimazolam versus propofol in elderly patients undergoing colonoscopy

目的评价甲苯磺酸瑞马唑仑与丙泊酚用于老年无痛结肠镜检查的有效性及安全性。方法择期拟行无痛结肠镜检查的老年40例,性别不限,年龄65~75岁,BMI 18~30 kg/m^(2)。ASA分级为Ⅱ~Ⅲ级。采取随机数字表法分为甲苯磺酸瑞马唑仑组(R组)和丙泊酚组(P组),各20例。受检者入室后,给予芬太尼50 ug。1 min后2组分别给予甲苯磺酸瑞马唑仑5 mg、丙泊酚1.2 mg/kg。镇静评分(MOAA/S评分)<3分开始镜检。分别间断给予维持剂量甲苯磺酸瑞马唑仑1.5 mg、丙泊酚0.4 mg/kg,维持镇静评分<4分。记录维持量追加次数、诱导时间、手术时间、苏醒时间、失败例数。监测给药前(T_(0))、镜检即刻(T_(1)),以及置镜后1 min(T_(2))、3 min(T_(3))、5 min(T_(4))时的SBP、DBP、SpO_(2)。统计心动过缓、低血压、呼吸暂停、缺氧、注射痛、苏醒延迟,以及恶心呕吐发生例数。结果R组诱导时间明显长于P组,差异有统计学意义(P<0.05);手术时间等其余差异均无统计学意义(P>0.05)。P组患者T_(2)、T_(3)时点的SBP、DBP,以及T_(2)时点的SpO_(2)均较T_(0)时点明显下降;R组患者T_(2)、T_(3)时点的SBP、DBP,以及T_(2)时点的SpO_(2)明显高于P组。以上差异均有统计学意义(P<0.05)。R组不良事件发生率明显低于P组,差异有统计学意义(P<0.05)。结论与丙泊酚比较,甲苯磺酸瑞马唑仑复合芬太尼麻醉用于65~75岁老年人无痛结肠镜检查,麻醉效果好且安全性高。

Objective To evaluate the efficacy and safety of remaolam and propofol for painless colonoscopy in the elderly.Methods Forty elderly patients with planned painless colonoscopy were selected,aged 65 to 75 years,BMI 18 to 30 kg/m^(2),ASAⅡ~Ⅲ,regardless of gender.The patients were randomly divided into remazolam(group R)and propofol(group P),with 20 patients in each group.After the patient entered the examination room,the patient was given fentanyl 50 ug.After 1 min,both groups were given remazolam 5 mg and propofol 1.2 mg/kg.Examination was started at the sedation score(MOAA/S score)<3,and both groups received intermittent maintenance doses of remazam 1.5 mg and propofol 0.4 mg/kg,respectively,with maintenance sedation score<4.To record the number of maintenance additions,induction time,operation time,awakening time,and the number of failures.To monitor SBP,DBP,SpO_(2) before the anesthesia,at the beginning of the examination,and at 1 min,3 min and 5 min after the start.The number of bradycardia,hypotension,apnea,hypoxia,injection pain,delayed awakening,and occurrence of nausea and vomiting were recorded.Results The induction time in group R was significantly longer than that of group P,with statistically significant differences(P<0.05).SBP and DBP at T_(2) and T_(3) and SpO_(2) at T_(2) decreased significantly compared with T0 in group P(P<0.05).SBP,DBP in R groups at points T_(2) and T_(3),and SpO_(2) at points T_(2) higher than of group P.The above differences were statistically significant(P<0.05).The incidence of adverse events in group R was significantly lower than that of group P,and the difference was statistically significant(P<0.05).Conclusion Rimazolam compound fentanyl is safe and feasible for elderly painless colonoscopy,and is more safe and effective than propofol.