瑞马唑仑复合丙泊酚在无痛内镜逆行胰胆管造影术中的应用

Application of remimazolam combined with propofol in painless endoscopic retrograde cholangiopancreatography

目的:观察与比较瑞马唑仑、丙泊酚单用及合用在经内镜逆行胰胆管造影术(ERCP)麻醉中的效果及安全性。方法:择期行ERCP治疗的120例患者按随机数字表分为丙泊酚组(P组)、瑞马唑仑组(R组)、瑞马唑仑联合丙泊酚组(RP组),每组各40例,3组按指定的用药方案(P组用丙泊酚;R组用瑞马唑仑;RP组瑞马唑仑联合丙泊酚)完成麻醉。比较3组患者的一般资料、手术时间和苏醒时间及麻醉前(T_(0))、麻醉后(T_(1)),置镜时(T_(2))、十二指肠乳头切开(T_(3))、支架或鼻胆管置入(T_(4))的血氧饱和度(SpO_(2))、心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脑电双频指数(BIS),Ramsay镇静评分;记录与比较术中加药总次数,体动、肠蠕动过快人次数;呼吸、心血管相关不良事件和麻醉相关的术后并发症。结果:3组患者一般资料、手术时间、苏醒时间,Ramsay镇静评分,手术医师、患者满意度及麻醉相关的术后并发症发生率差异无统计学意义(P>0.05);与P组比较,R组和RP组注射痛、低血压、心动过缓和呼吸抑制、胆心反射发生率低;麻醉后RR及BIS值高,差异有统计学意义(P<0.05)。与R组比较,P组和RP组加药总次数、体动和肠蠕动过快人次数少,差异有统计学意义(P<0.05)。结论:瑞马唑仑联合丙泊酚用于ERCP麻醉效果可,过程平稳,不良反应少,值得在临床推广应用。

AIM:To observe and compare the clinical efficacy and safety of remimazolam and propofol alone and in combination in endoscopic retrograde cholangiopancreatography(ERCP)anesthesia.METHODS:A total of 120 patients undergoing elective ERCP were divided into the propofol group(P group),the remimazolam group(R group),and the remimazolam combined with propofol group(RP group)according to a random number table,with 40 patients in each group,and the three groups completed anesthesia according to the designated drug regimen(propofol in group P;remimazolam in group R;and remimazolam combined with propofol in group RP).General information,operation time and awakening time of the patients in the three groups were compared,as well as oxygen saturation(SpO2),heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),electroencephalography bifrequency index(BIS),and Ramsay's sedation score before anesthesia(T0),after anesthesia(T1),at the time of placement of the scope(T2),duodenal papillotomy(T3),and stenting or placement of a nasobiliary catheter(T4);the total number of intraoperative medication additions,number of somatic motions,and number of intestinal peristalsalsis;and the number of respiratory,cardiovascular-related adverse events and anesthesia-related postoperative complications were recorded and compared.RESULTS:There was no statistically significant difference in the general information,operation time,awakening time,Ramsay sedation score,surgeon,patient satisfaction and the incidence of anesthesia-related postoperative complications among the three groups(P>0.05).Compared with the P group,the R and RP groups had lower incidence of injection pain,hypotension,bradycardia and respiratory depression,and bile heart reflex;the post-anesthesia RR and BIS values were high,and the differences were statistically significant(P<0.05).Compared with the R group,the P and RP groups had less number of somatic and intestinal motility hyperactivity,and the difference was statistically significant(P<0.05).CONCLUSION:Remimazolam combined with propofol for ERCP anesthesia can be effective,the process is smooth,and the adverse reactions are few,which is worth to promote the application in the clinic.