瑞马唑仑复合丙泊酚对无痛胃镜检查患者膈肌运动的影响

Effects of remimazolam combined with propofol on diaphragmatic muscle movement in patients undergoing painless gastroscopy

目的探讨超声监测下瑞马唑仑复合丙泊酚对胃镜检查患者膈肌运动的影响。方法选择2021年7-10月行无痛胃镜检查患者210例,男96例,女114例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:瑞马唑仑复合丙泊酚组(R组)和丙泊酚组(P组),每组105例。两组分别于入室吸氧5 min后缓慢静脉注射布托啡诺0.01 mg/kg,1 min后R组静脉注射瑞马唑仑0.2 mg/kg和丙泊酚0.5 mg/kg,P组静脉注射丙泊酚2 mg/kg,给药完成后即刻评估改良警觉/镇静(MOAA/S)评分,之后每30秒进行一次评估,直至MOAA/S评分≤3分时开始进镜操作。若进镜失败或给药2 min后MOAA/S评分仍≥4分,则追加丙泊酚0.5 mg/kg,直至MOAA/S评分≤3分,每次追加药物间隔时间≥1 min。记录注药前1 min(T_(1))、操作开始即刻(T_(2))、操作开始后1 min(T_(3))、苏醒(T_(4),Steward评分≥4分)时的HR、MAP、SpO_(2)和RR。记录T_(1)、T_(3)、T_(4)时的膈肌运动幅度(DM)、吸气末膈肌厚度(TEI)、呼气末膈肌厚度(TEE),根据公式计算出膈肌厚度变化率(DTF)=(TEI-TEE)÷TEI。记录首次诱导成功例数、麻醉诱导时间、苏醒时间和达离院标准时间。记录低氧血症、呼吸抑制和注射痛等不良反应发生情况。结果与P组比较,R组T_(3)时DM、DTF明显增大,低氧血症、呼吸抑制和注射痛发生率明显降低(P<0.05)。两组首次诱导成功率、麻醉诱导时间、苏醒时间、达离院标准时间差异无统计学意义。结论瑞马唑仑复合小剂量丙泊酚用于无痛胃镜检查安全有效,与单用丙泊酚比较,可以减轻对无痛胃镜检查患者膈肌运动的抑制程度,更好地保留患者自主呼吸,减少呼吸抑制和低氧血症的发生。

Objective To investigate the effect of remazolam combined propofol on diaphragm movement in patients with gastroscopy under ultrasound monitoring.Methods A total of 210 patients who underwent painless gastroscopy from July 2021 to October 2021 were selected,96 males and 114 females,aged 18-64 years,BMI 18-25 kg/m^(2),ASA physical statusⅠorⅡ.The patients were divided into two groups by random number table method:remazolam composite propofol group(group R)and propofol group(group P),105 patients in each group.Two groups were injected butorphanol 0.01 mg/kg slowly after 5 minutes of intravenous oxygen intake,remazolam 0.2 mg/kg and propofol 0.5 mg/kg in group R after 1 minute,while propofol 2 mg/kg in group P,and the modified alertness/sedation(MOAA/S)score was evaluated immediately after the completion of administration,and then every 30 seconds until the MOAA/S score was≤3 points.If the MOAA/S score is still≥4 points after 2 minutes of admission,propofol 0.5 mg/kg was added until MOAA/S score≤3 points,and the interval between each additional drug is≥1 minute.HR,MAP,SpO_(2)and RR were recorded 1 minute before injection(T_(1)),immediately after the start of operation(T_(2)),1 minute after the start of operation(T_(3)),and awakening(T_(4),Steward score≥4).The diaphragm motion range(DM),espiratory end-diaphragm thickness(TEI),and end-expiratory diaphragm thickness(TEE)were recorded at T_(1),T_(3),and T_(4),and the diaphragm thickness change rate(DTF)=(TEI-TEE)÷TEI was calculated according to the formula.The number of successful first induction,anesthesia induction time,awakening time,and standard time of discharge were recorded.The occurrence of adverse events such as hypoxemia,respiratory depression,and injection pain were also recorded.Results Compared with group P,DM and DTF were increased significantly in group R at T_(3),and the incidence of hypoxemia,respiratory depression,and injection pain were significantly decreased in group R(P<0.05).There were no significant differences in the success rate of first induction,the time of induction of anesthesia,the time of awakening,and the time of reaching the standard time of discharge of the two groups.Conclusion Remazolam combined with low-dose propofol is safe and effective for painless gastroscopy,and compared with propofol,it can reduce the degree of inhibition of diaphragmatic movement in painless gastroscopy patients,better preserve spontaneous breathing,and reduce the occurrence of respiratory depression and hypoxemia.