瑞马唑仑复合不同阿片类药物在无痛胃镜检查中的应用效果

Effect of remimazolam combined with different opioids in painless gastroscopy

目的通过比较瑞马唑仑复合不同阿片类药物与单纯瑞马唑仑用于无痛胃镜检查的临床效果,探讨瑞马唑仑与不同阿片类药物的合理配伍用药方式。方法选择2020年11月至2020年12月在扬州大学附属医院拟行无痛胃镜检查的患者160例,性别不限,年龄18~64岁,ASA分级Ⅰ、Ⅱ级,BMI 18~30 kg/m^(2)。采用随机数字表法将患者分为4组(每组40例):瑞马唑仑复合芬太尼组(PF组)、瑞马唑仑复合舒芬太尼组(PS组)、瑞马唑仑复合瑞芬太尼组(PR组)及单纯瑞马唑仑组(P组)。P组单纯静脉注射瑞马唑仑0.3 mg/kg,PF组、PS组、PR组分别静脉注射芬太尼50μg、舒芬太尼0.1μg/kg、瑞芬太尼0.25μg/kg行镇痛预处理后60 s内静脉注射瑞马唑仑0.3 mg/kg,当改良警觉/镇静评估(Modified Observer's Assessment of Alertness/Sedation,MOAA/S)评分<2分时开始胃镜操作。记录麻醉诱导前(T_(0))、入镜即刻(T_(1))、入镜后3 min(T_(2))、入镜后5 min(T_(3))的MAP、心率、SpO_(2),记录首剂镇静成功率、检查时间、苏醒时间、离院时间、术中不良反应发生率,记录术毕内镜医师与术后24 h患者对麻醉效果满意度的数字分级评分法(Numerical Rating Scale,NRS)评分及愿意再接受同样镇静方法的患者例数。结果与P组比较,PF组、PS组、PR组首剂镇静成功率升高(P<0.05),检查时间缩短(P<0.05),术毕内镜医师满意度NRS评分增加(P<0.05);与PR组比较,P组、PF组、PS组离院时间增加(P<0.05);4组苏醒时间、术后24 h患者满意度NRS评分及愿意再接受相同镇静方法的患者比例差异无统计学意义(P>0.05)。与P组比较,T_(1)时PS组、PR组心率降低,T_(2)时PF组、PS组、PR组MAP升高(P<0.05);与T_(0)时比较,T_(1)、T_(2)、T_(3)时4组MAP均降低(P<0.05),T_(1)时P组心率升高(P<0.05);其余时点各组MAP、心率和SpO_(2)比较差异无统计学意义(P>0.05)。与P组比较,PF组、PS组、PR组体动、呛咳、呃逆发生率降低(P<0.05);与PF组比较,PR组呛咳发生率降低(P<0.05);4组患者低氧血症、低血压、心动过缓、注射痛比较差异无统计学意义(P>0.05)。结论瑞马唑仑复合阿片类药物行无痛胃镜检查可明显提高镇静成功率、减少不良反应的发生,瑞马唑仑复合瑞芬太尼为更优方案。

Objective To investigate the clinical effect of remimazolam combined with different opioids and remimazolam alone,and discuss the rational compatibility of remimazolam with different opioids.Methods A total of 160 patients,men or women,aged 18‒64 years,American Society of Anesthesiologists(ASA)ⅠorⅡ,with body mass index(BMI)of 18‒30 kg/m^(2),who were scheduled for painless gastroscopy in Affiliated Hospital of Yangzhou University from November to December 2020 were selected.According to the random number table method,they were divided into four groups(n=40):a remazolam combined with fentanyl group(group PF),a remazolam combined with sufentanil group(group PS),a remazolam combined with remifentanil group(group PR)and a remazolam group(group P).Group P was intravenously injected with remimazolam 0.3 mg/kg.Meanwhile,groups PF,PS and PR were intravenously injected with fentanyl 50μg,sufentanil 0.1μg/kg,and remifentanil 0.25μg/kg for anesthesia prereatment,followed by intravenous injected of 0.3 mg/kg remimazolam over 60 s.When the Modified Observer's Assessment of Alertness/Sedation(MOAA/S)<2,gastroscopy was performed.Their mean arterial pressure(MAP),heart rate and pulse oxygen saturation(SpO_(2))were recorded before anesthesia induction(T_(0)),immediately after entering the endoscope(T_(1)),3 min after entering the endoscope(T_(2))and 5 min after entering the endoscope(T_(3)).The success rate of first dose sedation,gastroscopy time,recovery time,discharge time,the incidence of intraopthe number of patients who would like accept the same sedation method in the future were recorded.Results Compared with group P,groups PF,PS and PR showed increases in the success rate of first dose sedation(P<0.05),shorten examination time(P<0.05),and increased NRS score of endoscopist satisfaction at the end of surgery(P<0.05).Compared with group PR,groups P,PF,and PS presented extended length of hospitalization stay(P<0.05).There was no statistical difference in recovery time,NRS score of patient satisfaction within 24 h and the proportion of patients who would like to accept the same sedation method among the four groups(P>0.05).Compared with group P,the heart rate of groups PS and PR decreased at T_(1),and the MAP of groups PF,PS and PR increased at T_(2)(P<0.05).Compared with those at T_(0),MAP in groups T_(1),T_(2)and T_(3)decreased(P<0.05),and heart rate in group P was increased at T_(1)(P<0.05).There was no significant difference in MAP,heart rate and SpO_(2)among all groups at other time points(P>0.05).Compared with group P,the incidence of body movement,cough and hiccup in groups PF,PS and PR were reduced(P<0.05).Compared with group PF,the incidence of cough in group PR was reduced(P<0.05).There was no statistical difference in hypoxemia,hypotension,bradycardia and injection pain among the four groups(P>0.05).Conclusions Remimazolam combined with opioids for painless gastroscopy can significantly improve the success rate of sedation and reduce adverse reactions,remimazolam combined with remifentanil is optimal for painless gastroscopy.