瑞马唑仑或丙泊酚联合纳布啡用于无痛胃肠镜麻醉的对照研究

A comparative study of remazolam or propofol combined with nalbuphine for painless gastroenteroscopy anesthesia

目的比较瑞马唑仑或丙泊酚联合纳布啡用于无痛胃肠镜检查对患者呼吸循环、认知功能及不良反应的影响。方法选择拟行无痛胃肠镜检查患者100例,随机分为瑞马唑仑联合纳布啡组(RN组)和丙泊酚联合纳布啡组(PN组),每组各50例。观察两组患者检查前(T0)、胃镜结束时(T_(1))、肠镜结束时(T_(2))和苏醒时(T3)时的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)及血氧饱和度(SpO_(2));记录两组患者的镜检操作时间、苏醒时间,检查期间不良反应,分别测评医生及患者对麻醉的满意度,随访患者检查前、清醒后30 min、1 h、3 h、6 h的简易精神状态检查量表(MMSE)评分。结果RN组患者在T_(1)、T_(2)及T3时点MAP及RR值明显高于PN组(t分别=4.51、7.87、2.83、2.00、4.41、6.13,P均<0.05),在T_(1)、T_(2)时点,RN组患者的SpO_(2)值明显高于PN组,HR值明显低于PN组(t分别=3.88、2.62、-3.90、-2.57,P均<0.05);两组患者操作时间及苏醒时间比较,差异无统计学意义(t分别=0.74、1.96,P均>0.05);RN组低血压、呼吸抑制及注射痛的发生率明显低于PN组(χ^(2)分别=10.45、4.64、13.89,P均<0.05),两组患者在恶心呕吐、术者及患者满意度及术前、清醒后30 min、清醒后1 h、清醒后3 h、清醒后6 h MMSE评分方面比较,差异无明显统计学意义(χ^(2)分别=0.00、0.84、0.00;t分别=1.53、1.13、1.45、1.03、1.36,P均>0.05)。结论瑞马唑仑或丙泊酚联合纳布啡用于无痛胃肠镜检查对患者认知功能影响相当,瑞马唑仑联合纳布啡麻醉不良反应少,呼吸循环更稳定。

Objective To compare the effects of remazolam or propofol combined with nalbuphine in painless gastroscopy on respiratory and circulatory function,cognitive function and adverse reactions.Methods A total of 100 patients who planned to undergo painless gastroenteroscopy were randomly divided into remazolam combined with nalbuphine(RN)and propofol combined with nalbuphine(PN),with 50 patients in each group.The mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_(2))and respiratory rate(RR)of the two groups were observed before examination(T0),at the end of gastroscopy(T_(1))and at the end of enteroscopy(T_(2))when patients woke up(T3).The operation time,recovery time,and adverse reactions during examination were recorded.The satisfaction of doctors and patients with anesthesia and the MMSE scores of patients before examination and 30 minutes,1 hour,3 hours and 6 hours after waking up were evaluated.Results The RR and MAP at T_(1),T_(2)and T3in the RN group were significantly higher than those in the PN group(t=4.51,7.87,2.83,2.00,4.41,6.13,P<0.05),At T_(1)and T_(2),the SpO_(2)in the RN group was significantly higher than that in the PN group,and the HR was significantly lower than PN group(t=3.88,2.62,-3.90,-2.57,P<0.05).There was no significant difference between the two groups in operation time and awakening time(t=0.74,1.96,P>0.05).In terms of adverse reactions,the incidence of hypotension,respiratory depression and injection pain in the RN group were significantly lower than those in the PN group(χ^(2)=10.45,4.64,13.89,P<0.05).There was no significant difference between the two groups in nausea and vomiting,doctor and patient satisfaction,MMSE scores before operation,30min,1h,3h and 6h after waking(χ^(2)=0.00,0.84,0.00,t=1.53,1.13,1.45,1.03,1.36,P>0.05).Conclusion Remazolam or propofol combined with halbuphine for painless gastroscopy has a similar effect on cognitive function of patients.Remazolam combined with halbuphine has fewer adverse reactions and more stable respiratory and circulatory.