甲苯磺酸瑞马唑仑在老年患者超声胃镜检查中的临床应用

Clinical application of remimazolam tosilate in elderly patients during endoscopic ultrasonography

目的探讨甲苯磺酸瑞马唑仑用于老年患者超声胃镜检查时对血流动力学及安全性的影响。方法选取青岛大学附属医院2021年6月至10月行超声胃镜检查的老年患者84例, 采用随机数字表法分为对照组(C组)和试验组(R组), 每组42例。两组患者给予舒芬太尼后, C组应用丙泊酚镇静, R组应用瑞马唑仑镇静。记录两组患者入室时(T0)、镇静药给药结束后(T_(1))、进镜时(T_(2))、进镜后5 min(T_(3))、出镜时(T_(4))、出镜后30 min(T_(5))6个时点的心率、血压、呼吸频率(respiratory rate, RR)、SpO_(2)、BIS、改良警觉/镇静评估(Modified Observer''s Assessment of Alertness/Sedation, MOAA/S)评分, 记录两组患者手术操作时间、苏醒时间、定向力恢复时间, 记录两组患者术中注射痛、低血压、心动过缓、呼吸抑制、术中知晓发生率, 记录两组患者术后恶心呕吐、躁动、头晕发生率及满意度。结果 T0时点, 两组患者血压、心率、SpO_(2)、BIS比较差异无统计学意义(P>0.05);R组血压、心率在T_(1)、T_(2)、T_(3)、T_(4)、T_(5) 5个时点均高于C组(P<0.05), R组的SpO_(2)、BIS在T_(1)、T_(2)、T_(3)、T_(4) 4个时点均高于C组(P<0.05)。与C组比较, R组镇静起效时间延长(P<0.05), 苏醒时间和定向力恢复时间缩短(P<0.05)。与C组比较, R组术中注射痛、低血压、呼吸抑制、心动过缓发生率均降低(P<0.05)。两组患者均未发生术中知晓。两组患者术后恶心呕吐、躁动、头晕发生率及满意度比较差异无统计学意义(P>0.05)。结论瑞马唑仑应用于老年患者超声胃镜检查有利于患者血流动力学平稳, 安全性较高, 苏醒快, 不良反应少。

Objective To investigate the effects of remimazolam tosilate on the hemodynamics and safety of elderly patients during endoscopic ultrasonography.Methods A total of 84 elderly patients who underwent endoscopic ultrasonography in the Affiliated Hospital of Qingdao University from June to October 2021 were selected.According to the random number table method,they were divided into two groups(n=42):a control group(group C)and an experimental group(group R).All the patients were administered with sufentanil.Then,patients in group C were given propofol for sedation,whereas those in group R received remimazolam.Their heart rate,blood pressure,respiratory rate(RR),pulse oxygen saturation(SpO_(2)),bispectral index(BIS)and the Modified Observer's Assessment of Alertness/Sedation(MOAA/S)scores were recorded at the time of admission into the operating room(T0),at the end of sedative administration(T_(1)),at the time of inserting the endoscopy(T_(2)),5 min after entering the endoscope(T_(3)),at the time of retracting the endoscope(T_(4))and 30 min after retracting the endoscope(T_(5)).The operation time,emergence time and the time of recovery of orientation in the two groups were recorded.The incidences of intraoperative injection pain,hypotension,bradycardia,respiratory depression and intraoperative awareness were recorded.The incidences of postoperative nausea and vomiting,agitation,dizziness and satisfaction were recorded.Results There was no statistical difference in blood pressure,heart rate,SpO_(2) and BIS between the two groups at T0.Blood pressure and HR in group R were higher than those in group C at T_(1),T_(2),T_(3),T_(4) and T_(5)(P<0.05).SpO_(2) and BIS in group R were higher than those in group C at T_(1),T_(2),T_(3) and T_(4)(P<0.05).Compared with group C,group H showed prolonged onset time of sedation(P<0.05),and shortened emergence time and time of recovery of orientation(P<0.05).Compared with group C,group R showed decreased incidences of intraoperative injection pain,hypotension,respiratory depression and bradycardia(P<0.05).No intraoperative awareness occurred in both groups.There was no statistical difference in the incidences of postoperative nausea and vomiting,agitation,dizziness and satisfaction between the two groups(P>0.05).Conclusions Remimazolam is beneficial for elderly patients for ultrasonic gastroscopy,with stable hemodynamics,high safety,quick recovery and few adverse reactions.