瑞马唑仑-丙泊酚-阿芬太尼在无痛胃镜检查术中的应用效果

The Effect of Remimazzolam-propofol-alfentanil Application in Painless Gastroscopy

目的:评价瑞马唑仑-丙泊酚-阿芬太尼用于无痛胃镜检查术患者的麻醉效果和安全性。方法:选择我院2022年5月至8月行无痛胃镜检查术的患者90例,年龄18~59岁,BMI 18.5~28.0 kg/m^(2),ASAⅠ级或Ⅱ级。采用随机数字表法分为两组(n=45):瑞马唑仑-丙泊酚-阿芬太尼组(RPA组)和丙泊酚-阿芬太尼组(PA组)。两组均预先缓慢推注阿芬太尼6μg/kg, 1 min后RPA组依次静脉注射瑞马唑仑0.1 mg/kg,丙泊酚0.5 mg/kg, PA组静脉注射丙泊酚2 mg/kg。检查中根据实际情况追加丙泊酚0.5 mg/kg。待MOAA/s评分≤1分时开始行胃镜检查。记录两组患者的镇静有效率、麻醉起效时间、苏醒时间、胃镜检查时间、离院时间及术中不良反应的发生情况。结果:与PA组比较,RPA组患者麻醉起效时间延长,麻醉苏醒、离院时间缩短,低血压、呼吸抑制及心动过缓发生率下降(P<0.05)。两组患者的镇静有效率、胃镜检查时间、呛咳及注射痛发生率比较差异无统计学意义(P>0.05)。结论:与丙泊酚-阿芬太尼联合相比,瑞马唑仑-丙泊酚-阿芬太尼联合应用于无痛胃镜检查时麻醉苏醒时间缩短,低氧血症、心血管不良事件发生率降低,麻醉更安全有效。

Objective To evaluate the anesthetic effect and safety of remimazzolam-propofol-alfentanil in patients undergoing painless gastroscopy. Methods 90 patients with painless gastroscopy in our hospital from May 2022 to August 2022, aged 18~59 years, BMI 18.5~28.0 kg/m^(2), ASA Ⅰ or Ⅱ grade, were selected. They were divided into two groups(n=45) by random number table method: rimazzolam-propofol-alfentanil group(RPA group) and propofol-alfentanil group(PA group). Both groups were slowly injected with alfentanil 6 μg/kg in advance. 1 min later, the RPA group received intravenous injection of remimazolam 0.1 mg/kg and propofol 0.5 mg/kg sequentially, and the PA group received intravenous injection of propofol 2 mg/kg. 0.5 mg/kg propofol was added according to the actual situation. Gastroscopy was started when MOAA/s score was ≤1. The effective rate of sedation, the onset time of anesthesia, the time of awakening, the time of gastroscopy, the time of leaving hospital and the occurrence of intraoperative adverse reactions were recorded in the two groups of patients. Results Compared with PA group, the onset time of anesthesia in RPA group was prolonged, the time of anesthesia awakening and leaving hospital was shorter, and the incidence of hypotension, respiratory depression and bradycardia decreased(P<0.05). There was no significant difference in the effective rate of sedation, the time of gastroscopy, the incidence of cough and injection pain between the two groups(P>0.05). Conclusion Compared with propofol-alfentanil combination, the anesthesia recovery time of remimazzolam-propofol-alfentanil combination in painless gastroscopy is shortened, the incidence of hypoxemia and cardiovascular adverse events is reduced, and anesthesia is safe and more effective.