年龄及性别因素对瑞马唑仑用于无痛胃镜检查有效剂量的影响

The influence of age and gender on the effective dose of remimazolam combined with alfentanil for painless gastroscopy

目的探讨年龄及性别因素对瑞马唑仑用于无痛胃镜检查半数有效剂量(median effective dose,ED_(50))的影响。方法选择行无痛胃镜检查术的患者,按年龄及性别分为6组,A组:青年女性(18~44岁),B组:中年女性(45~59岁),C组:老年女性(60~75岁),D组:青年男性(18~44岁),E组:中年男性(45~59岁),F组:老年男性(60~75岁)。入室给予阿芬太尼10μg/kg及试验剂量瑞马唑仑,设定0.20 mg/kg为初始剂量,采用改良序贯法确定下一例患者剂量,记录各剂量瑞马唑仑镇静效果及各组不良反应发生情况。采用概率回归分析各组瑞马唑仑ED_(50)、95%置信区间(confidence interval,CI)及量效关系。结果纳入167例患者,其中A组26例,B组25例,C组27例,D组28例,E组33例以及F组28例。A组瑞马唑仑的ED_(50)(0.33 mg/kg,95%CI:0.26~0.37 mg/kg)较C~F组多,且差异有统计学意义(P<0.05);B组ED_(50)(0.32 mg/kg,95%CI:0.24~0.36 mg/kg)大于C、E以及F组,余各组ED_(50)及不良反应的发生无统计学差异。结论瑞马唑仑复合阿芬太尼用于无痛胃镜检查时,青中年女性ED_(50)高于老年女性及同年龄段男性患者。

Objectives To investigate the influence of age and gender on the median effective dose of remimazolam for painless gastroscopy.Methods Patients who underwent painless gastroscopy were divided into 6 groups according to age and gender,group A:young women(18~44 years old),group B:middle-aged women(45~59 years old),group C:elderly women(60~75 years old),group D:young men(18~44 years old),group E:middle-aged men(45~59 years old),and group F:elderly men(60~75 years old).Patients were administrated with 10μg/kg alfentanil and different dose of remimazolam,and 0.20 mg/kg was set as the initial dose.The dose of remimazolam of the next patient was determined by the Dixon’up-down modified sequential method.The sedative effect of different doses of remimazolam and the occurrence of adverse reactions in each group were recorded.Probabilistic regression analysis was used to analyze the median effective dose(ED_(50)),95%confidence interval(CI)and dose-response relationship of remimazolam in each group.Results A total of 167 patients were finally enrolled,including 26 cases in group A,25 cases in group B,27 cases in group C,28 cases in group D,33 cases in group E and 28 cases in group F.The ED_(50)of remimazolam in group A(0.33 mg/kg,95%CI:0.26~0.37 mg/kg)was higher than that in group C~group F,and the differences were statistically significant(P<0.05).The ED_(50)of group B(0.32 mg/kg,95%CI:0.24~0.36 mg/kg)was higher than that in group C,E and F,and the differences were statistically significant.There was no statistically difference in ED_(50)and adverse reactions among the other groups.Conclusion ED_(50)of remimazolam combined with alfentanil used for painless gastroscopy in young and middle-aged females was higher than that in same age males and elderly women.