芬太尼复合瑞马唑仑抑制胃镜置入反应半数有效剂量

MEDIAN EFFECTIVE DOSE OF REMIMAZOLAM IN INHIBITING REACTIONS TO GASTROSCOPE INSERTION WHEN USED IN COMBINATION WITH FENTANYL

目的探讨复合芬太尼时瑞马唑仑抑制病人胃镜置入反应的半数有效剂量(ED 50)。方法选择择期拟行无痛胃镜检查病人为研究对象,性别不限,年龄18~60岁,体质量指数18~30 kg/m^(2),ASA分级Ⅰ或Ⅱ级。所有病人均给予芬太尼1μg/kg复合瑞马唑仑静脉麻醉,根据改良Dixon序贯法确定瑞马唑仑的剂量。瑞马唑仑初始剂量0.20 mg/kg,根据胃镜置入反应确定下一例病人瑞马唑仑剂量,出现阳性反应时下一例病人采用高一级剂量,出现阴性反应时采用低一级剂量,剂量梯度为0.02 mg/kg,直至出现7次阳性反应转阴性反应转折点则停止试验。置入胃镜时病人出现皱眉、吞咽、体动或呛咳反应判定为阳性。采用Probit概率法计算瑞马唑仑抑制胃镜置入反应的ED 50及其95%可信区间(CI)。结果共30例病人完成试验。复合芬太尼1μg/kg时,瑞马唑仑抑制病人胃镜置入反应的ED 50及其95%CI为0.157(0.140~0.171)mg/kg。结论复合芬太尼1μg/kg时,瑞马唑仑抑制病人胃镜置入反应的ED 50为0.157 mg/kg。

Objective To determine the median effective dose(ED 50)of remimazolam in inhibiting reactions to gastroscope insertion when used in combination with fentanyl.Methods Both male and female patients who planned to undergo elective painless gastroscopy were enrolled as subjects,with an age of 18-60 years,a body mass index of 18-30 kg/m^(2),and an ASA grade ofⅠorⅡ.All patients were given fentanyl 1μg/kg combined with remimazolam for intravenous anesthesia,and the dose of remimazolam was determined by the modified Dixon’s up-and-down method.The initial dose of remimazolam was 0.20 mg/kg,and the dose of remimazolam for the next patient was determined according to the reactions to gastroscope insertion.A higher dose level was adopted in case of positive reactions,and a lower dose level was adopted in case of negative reactions,with a dose gradient of 0.02 mg/kg.The trial was stopped at the turning point when positive reactions became negative reactions for the 7th time.Positive reactions were defined as the occurrence of frowning,swallowing,body movement,or bucking during gastroscope insertion.The Probit method was used to calculate the ED 50 and 95%confidence interval(CI)of remimazolam in inhibiting reactions to gastroscope insertion.Results A total of 30 patients completed the trial.When used in combination with fentanyl 1μg/kg,remimazolam had an ED 50 of 0.157(95%CI=0.140-0.171)mg/kg in inhibiting reactions to gastroscope insertion.Conclusion Remimazolam has an ED 50 of 0.157 mg/kg in inhibiting reactions to gastroscope insertion when used in combination with fentanyl 1μg/kg.