不同剂量瑞马唑仑用于老年患者无痛胃镜诊疗的效果

Effect of different doses of remazolam on painless gastroscopy in elderly patients

目的观察三种剂量瑞马唑仑用于老年患者无痛胃镜诊疗的临床效果。方法选择择期行无痛胃镜诊疗的老年患者158例,男78例,女80例,年龄≥65岁,BMI 18~28 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字法将患者分为四组:丙泊酚组(P组,n=40)、瑞马唑仑0.2 mg/kg组(R2组,n=38)、瑞马唑仑0.3 mg/kg组(R3组,n=40)和瑞马唑仑0.4 mg/kg组(R4组,n=40)。R2组、R3组、R4组分别静脉注射瑞马唑仑0.2、0.3和0.4 mg/kg,P组静脉注射丙泊酚1.5 mg/kg,胃镜诊疗中根据实际情况追加瑞马唑仑5 mg或丙泊酚0.5 mg/kg。患者在行胃镜诊疗前均含服达克罗宁胶浆10 ml、静脉滴注舒芬太尼5μg进行镇痛处理。记录患者入睡时间、苏醒时间、离开麻醉恢复室时间和低血压、呼吸抑制、注射痛等不良反应的发生情况。结果与P组比较,R3组、R4组入睡时间明显缩短(P<0.05),R4组苏醒时间明显延长(P<0.05),R2组、R3组离开恢复室时间明显缩短(P<0.05)。与R3组比较,R2组入睡时间明显延长(P<0.05),R4组苏醒时间和离开恢复室时间明显延长(P<0.05)。与P组比较,R2组、R3组、R4组低血压、呼吸抑制、注射痛的发生率明显降低(P<0.05)。结论瑞马唑仑用于老年患者无痛胃镜诊疗较丙泊酚在稳定血流动力学指标方面更具优势,其中瑞马唑仑0.3 mg/kg能更好地提高患者苏醒质量、加快恢复室病床周转率及降低不良反应发生率。

Objective To observe the clinical effect of three different doses of remazolam on painless gastroscopy in elderly patients.Methods A total of 158 elderly patients,78 males and 80 females,age≥65 years,BMI 18-28 kg/m^(2),ASA physical statusⅡorⅢ,were randomly divided into four groups:propofol group(group P,n=40),remazolam 0.2 mg/kg group(group R2,n=38),remazolam 0.3 mg/kg group(group R3,n=40)and remazolam 0.4 mg/kg group(group R4,n=40).The patients in groups R2,R3 and R4 received intravenous injection of 0.2,0.3 and 0.4 mg/kg of remazolam respectively.The patients in group P received intravenous injection of 1.5 mg/kg propofol.Remazolam 5 mg/kg or propofol 0.5 mg/kg was added according to the actual situation during gastroscopy.All patients were pretreated with dacronine gel 10 ml and sufentanil 5μg intravenously before gastroscopy.The time of falling asleep,waking up,leaving the anesthesia recovery room and the occurrence of adverse reactions such as hypotension,respiratory depression,injection pain,et al were recorded.Results Compared with group P,the time to fall asleep in group R3 and group R4 was significantly shorter(P<0.05),the time of awakening up in group R4 was significantly prolonged(P<0.05),and the time of leaving the recovery room in group R2 and group R3 was significantly shorter(P<0.05).Compared with group R3,the time to fall asleep in group R2 was significantly longer(P<0.05),and the time of awakening up and leaving the recovery room in group R4 were significantly longer(P<0.05).Compared with group P,the incidence of hypotension,respiratory depression and injection pain in groups R2,R3 and R4 decreased significantly(P<0.05).Conclusion Compared with propofol,remazolam has more advantages in stabilizing hemodynamic indexes in the painless gastroscopy treatment of elderly patients,remazolam 0.3 mg/kg is the best in improving the quality of recovery,accelerating the rate of bed turnover in the recovery room and reducing the incidence of adverse reactions.