苯磺酸瑞马唑仑联合舒芬太尼在无痛纤维支气管镜检查中的效果及安全性

Effect and Safety of Remazolam Besylate Combined with Sufentanil in Painless Fiberoptic Bronchoscopy

目的分析苯磺酸瑞马唑仑联合舒芬太尼在无痛纤维支气管镜检查中的效果及安全性。方法选取2022年10月至2023年4月山东省立第三医院收治的80例行无痛纤维支气管镜检查患者为研究对象,根据患者麻醉方式不同分为研究组和对照组,各40例。对照组采用丙泊酚(1~3 mg/kg,静脉推注)联合舒芬太尼(0.1μg/kg,静脉推注)麻醉;观察组采用苯磺酸瑞马唑仑(0.1~0.3 mg/kg,静脉推注)联合舒芬太尼(同对照组)麻醉。记录两组患者麻醉前(T_(1))、置纤维支气管镜前(T_(2))、置纤维支气管镜后2 min(T_(3))、苏醒时(T_(4))脉搏血氧饱和度(SpO_(2))、心率、平均动脉压(MAP)、警觉/镇静观察评分(OAA/S)、简易精神状态检查(MMSE)评分,比较两组患者检查过程中呛咳程度,麻醉与苏醒质量、检查时间、不良反应及麻醉满意度。结果不同时间点SpO_(2)、心率、MAP及OAA/S评分的主效应差异有统计学意义(P<0.01),不考虑测量时间,各指标组间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.05或P<0.01)。T_(1)时,两组SpO_(2)、心率、MAP及OAA/S评分水平比较差异无统计学意义(P>0.05);T_(2)、T_(3)时,研究组SpO_(2)水平高于对照组(P<0.05);T_(2)、T_(3)、T_(4)时,研究组心率、MAP水平高于对照组(P<0.05);T_(4)时,研究组OAA/S评分高于对照组(P<0.05)。不同时点间MMSE评分的主效应差异有统计学意义(P<0.01),不考虑测量时间,组间的主效应差异无统计学意义(P>0.05),组间和时点间无交互作用(P>0.05);苏醒后15、30 min时,两组MMSE评分低于入室时(P<0.05)。研究组患者检查过程中呛咳程度明显低于对照组(P<0.01)。研究组麻醉苏醒时间、麻醉清醒时间短于对照组[(4.2±1.2)min比(7.6±1.6)min、(13.4±5.2)min比(22.9±5.8)min](P<0.01)。研究组不良反应发生率低于对照组[7.50%(3/40)比32.50%(13/40)](χ^(2)=7.813,P=0.005)。研究组麻醉满意度明显优于对照组(P<0.01)。结论苯磺酸瑞马唑仑联合舒芬太尼应用于无痛纤维支气管镜检查中的麻醉效果更好,安全性更高,对术后认知功能影响较小,且能获得更佳的镇静作用、血流动力学及麻醉满意度。

Objective To analyze the effect and safety of remazolam besylate combined with sufentanil in painless fiberoptic bronchoscopy.Methods Eighty patients undergoing painless fiberoptic bronchoscopy admitted to Shandong Provincial Third Hospital from Oct.2022 to Apr.2023 were included,and were divided into a study group and a control group according to different anesthesia methods,with 40 cases in each group.The control group was given anesthesia with propofol(dose of 1-3 mg/kg,intravenous injection)combined with sufentanil(dose of 0.1μg/kg,intravenous injection),and the observation group was given anesthesia with remazolam besylate(dose of 0.1-0.3 mg/kg,intravenous injection)combined with sufentanil(dose same as the control group).The pulse oxygen saturation(SpO_(2)),heart rate,mean arterial pressure(MAP),observer′s assessment of alertness/sedation(OAA/S)score,and mini mental state examination(MMSE)score of the two groups at before anesthesia(T_(1)),before placing a fiberoptic bronchoscope(T_(2)),2 min after fiberbronchoscopy(T_(3)),when awake(T_(4))were recorded.The coughing degree during the examination,and the quality of anesthesia and recovery,examination time,adverse reactions and satisfaction with anesthesia were compared between the two groups.Results Differences in the main effects of SpO_(2),heart rate,MAP and OAA/S scores at different time points were statistically significant(P<0.01),regardless of the measurement time,the main effect differences of each index between groups were statistically significant(P<0.01),and there were interactions between groups and time points(P<0.05 or P<0.01).At T_(1),there was no significant difference in SpO_(2),heart rate,MAP and OAA/S score levels between the two groups(P>0.05);at T_(2)and T_(3),SpO_(2)levels of the study group were higher than the control group(P<0.05);at T_(2),T_(3)and T_(4),heart rate and MAP of the study group were higher than the control group(P<0.05);at T_(4),OAA/S score of the study group was higher than the control group(P<0.05).The difference in main effects of MMSE scores between different points was statistically significant(P<0.01),regardless of measurement time,the main effect difference was not statistically significant between groups(P>0.05),and there was no interaction between groups and time points(P>0.05);at 15 and 30 min after awakening,the MMSE scores were lower than at room entry(P<0.05).The degree of cough in the study group was significantly lower than that in the control group(P<0.01).The awakening time and sober time of the study group were shorter than those of the control group[(4.2±1.2)min vs(7.6±1.6)min,(13.4±5.2)min vs(22.9±5.8)min](P<0.01).The incidence of adverse reactions in the study group was lower than that in the control group[7.50%(3/40)vs 32.50%(13/40)](χ^(2)=7.813,P=0.005).The anesthesia satisfaction of the study group was significantly better than that of the control group(P<0.01).Conclusion The combination of remazolam besylate and sufentanil in painless fiberoptic bronchoscopy has better anesthesia effect,higher safety,less impact on postoperative cognitive function,and can achieve better sedation,blood flow,and anesthesia satisfaction.