瑞马唑仑在肥胖患者无痛胃肠镜检查术中的麻醉效果及安全性观察

Anesthetic efficacy and safety of remimazolam in painless gastrointestinal endoscopy for obese patients

目的 探讨瑞马唑仑在肥胖患者无痛胃肠镜检查术中的麻醉效果和安全性。方法 收集行无痛胃肠镜检查的肥胖患者80例,随机分为瑞马唑仑组与丙泊酚组各40例。患者入室后开放外周静脉通道,静脉注射芬太尼进行镇痛预处理,瑞马唑仑组静脉给予苯磺酸瑞马唑仑5 mg,丙泊酚组静脉给予丙泊酚中长链脂肪乳注射液1.5 mg/kg,术中根据情况追加麻醉药物。术中监测生命体征[平均动脉压(MAP)、心率(HR)和氧饱和度(SpO2)],记录低氧、呼吸暂停、亚临床呼吸抑制的发生情况。采用Ramsay麻醉量表评价麻醉效果,记录麻醉时间、胃镜操作时间和术后恢复时间;记录术后不良事件如呛咳、恶心呕吐、体动、注射痛、低血压等的发生情况。结果 两组Ramsay评分均达到4~6分,组间比较差异无统计学意义(P>0.05);两组麻醉时间、胃镜操作时间比较差异无统计学意义(P均>0.05),瑞马唑仑组术后恢复时间较丙泊酚组缩短(P<0.01)。两组麻醉前、苏醒后的MAP、HR、SpO2比较差异无统计学意义(P均>0.05);与瑞马唑仑组比较,丙泊酚组术中MAP、SpO2降低(P均<0.05),HR无明显变化(P>0.05)。在无痛胃肠镜检查过程中瑞马唑仑组低氧、呼吸暂停、亚临床呼吸抑制发生率均低于丙泊酚组(P均<0.05)。瑞马唑仑组恶心呕吐、体动、注射痛、低血压发生率均低于丙泊酚组(P均<0.05),两组呛咳发生率比较差异无统计学意义(P>0.05)。结论 瑞马唑仑在肥胖患者无痛胃肠镜检查术中具有较好的麻醉效果和安全性,能够减少术中和术后不良事件的发生。

Objective To explore the anesthetic efficacy and safety of remimazolam in painless gastrointestinal en⁃doscopy for obese patients.Methods Eighty obese patients undergoing painless gastrointestinal endoscopy were enrolled and then were randomly divided into two groups:the remimazolam group and the propofol group,with 40 in each.The pe⁃ripheral intravenous access was established.Fentanyl was injected intravenously for analgesic pretreatment,patients in the remazolam group were given 5 mg remimazolam,and patients in the propofol group were given 1.5 mg/kg propofol medi⁃um/long-chain fat emulsion injection,and anesthetic drugs were added according to the situation during the operation.We monitored the intraoperative vital signs,including mean arterial pressure(MAP),heart rate(HR),and oxygen saturation(SpO_(2)).Hypoxia,apnea and subclinical respiratory depression were recorded.The Ramsay Sedation Scale was em⁃ployed to assess the anesthesia effect.Anesthesia time,duration of endoscopic procedure,and postoperative recovery time were recorded.The adverse events such as coughing,nausea,vomiting,movement,injection pain,and hypotension were also recorded.Results Both groups achieved Ramsay scores of 4 to 6,with no statistically significant difference between groups(P>0.05).There was no statistically significant difference in sedation time or duration of endoscopic procedure be⁃tween the two groups(both P<0.05).However,the postoperative recovery time was significantly shorter in the remimazol⁃am group in comparison with that of the propofol group(P<0.01).No statistically significant differences were observed in pre-anesthetic and post-awakening MAP,HR,and SpO_(2) between the two groups(all P>0.05).In comparison with the remimazolam group,the propofol group exhibited decreased intraoperative MAP and SpO_(2)(both P<0.05),with no signifi⁃cant change in HR(P>0.05).During the painless gastrointestinal endoscopy procedure,the remimazolam group demon⁃strated lower incidences of hypoxia,respiratory pauses,and subclinical respiratory depression than the propofol group(all P<0.05).Compared with the propofol group,the remimazolam group exhibited lower rates of nausea,vomiting,move⁃ment,and injection pain,as well as hypotension(all P<0.05).The incidence of coughing did not show a statistically sig⁃nificant difference between the two groups(P>0.05).Conclusion The utilization of remimazolam for painless gastroin⁃testinal endoscopy in obese patients yields favorable anesthesia efficacy and safety,and can reduce the occurrence of intra⁃operative and postoperative adverse events.