瑞马唑仑单独或联合右美托咪定用于纤维支气管镜检查的效果

Clinical effect of remimazolam alone or in combination with dexmedetomidine in the diagnosis and treatment of fiberoptic bronchoscopy

目的观察瑞马唑仑单独或联合右美托咪定用于纤维支气管镜检查的临床效果。方法90例行纤维支气管镜检查的患者随机分为3组:C组,采用丙泊酚麻醉;R组,采用甲苯磺酸瑞马唑仑麻醉;RD组,采用甲苯磺酸瑞马唑仑复合右美托咪定麻醉。主要结局指标:围术期低氧血症的发生率。次要结局指标:瑞马唑仑的诱导用量和维持用量;术中患者的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)、SPO_(2)以及改良警觉/镇静(modified observer’s assessment of alert/sedation,MOAA/S)评分;呛咳评分和体动评分;患者意识消失时间和意识清醒时间;术中不良反应发生率。结果与C组相比,R组与RD组低氧血症、低血压和心动过速的发生率明显降低,差异有统计学意义(P<0.05),患者意识消失、意识清醒时间均延长,差异有统计学意义(P<0.05);与R组相比,RD组瑞马唑仑诱导用量和维持用量均减少,差异有统计学意义(P<0.05);3组患者呛咳、体动评分及MOAA/S镇静评分差异无统计学意义(P>0.05)。结论瑞马唑仑用于纤维支气管镜检查安全、有效,对呼吸、循环系统影响较丙泊酚轻,联合右美托咪定能够减少其诱导用量和维持用量,意识消失及意识清醒时间长于丙泊酚。

Objective:To observe the effect of remimazolam alone or combined with dexmedetomidine forfiberoptic bronchoscopy.Methods:This trial enrolled 90 eligible patients undergoing bronchoscopy under intravenous anesthesia.All patients were randomly separated into three groups:group C(propofol),group R(remimazolam)and group RD(remimazolam plusDex).The primary objective was the incidences of hyoxemia.Secondary indicators included induction dose and maintenance dose of remimazolam,oxygen saturation(SPO_(2)),heart rate(HR),mean arterial pressure(MAP)and MOAA/S scores,cough scores and limb movement scores,the time ofloss of consciousness and recovery.Results:Compared with the group C,the incidence of hypoxemia,hypotension and tachycardia in the group R and RD decreased significantly,the time ofloss of consciousness and recovery in group R and RD was extended(P<0.05).Compared with Group R,the induction dose and maintenance dose of remimazolam in group RD were reduced(P<0.05).Coughing score,limb movement score and MOAA/S score were not comparable in the three groups.Conclusion:Remimazolam is safe and effective for fiberoptic bronchoscopy.Compared with propofol,there is less effect on circulatory system and respiratory system.Compared with remimazolam,remimazolam combined with dexmedetomidinecan reduces dose of induction and maintenance for fiberoptic bronchoscopy.Compared with group C,the time ofloss of consciousness and recovery in group R and RD is extended.