纳布啡联合瑞马唑仑在无痛结直肠息肉EMR术中的临床应用

Clinical application of remimazolam combined with nalbuphine in painless EMR for colorectal polyps

目的探讨纳布啡联合瑞马唑仑在无痛结直肠息肉内镜下黏膜切除术(endoscopic mucosal resection,EMR)中安全性和有效性。方法选择行无痛结直肠息肉EMR术患者100例,采用随机数字表法分为纳布啡联合瑞马唑仑(remimazolam,NR)组和纳布啡联合丙泊酚(nalbuphine combined with propofol,NP)组,每组各50例。分别记录:入室后(T_(0))、给药后1分钟(T_(1))、手术开始第1分钟(T_(2))、第3分钟(T_(3))、第5分钟(T_(4))、手术结束时(T_(5))患者的平均动脉压、心率和血氧饱和度;对两组患者用药后的恢复情况进行记录,记录内容包括血管活性药物使用率、操作时间、意识消失时间、苏醒时间、补充镇静次数及纳布啡用量,发生不良反应概率、操作医生及患者满意度。结果NR组T_(1)、T_(2)、T_(3)、T_(4)、T_(5)的平均动脉压均高于NP组(P<0.05),T_(1)时NR组的心率高于NP组(P<0.05);NR组呼吸抑制、低血压、注射痛发生率、苏醒时间和血管活性药物使用率低于NP组(P<0.05);NR组操作医生满意度高于NP组(P<0.05);两组患者在操作时间、补充镇静次数、纳布啡用量、意识消失时间、血氧饱和度、头晕、恶心、呕吐等不良反应发生率比较差异均无统计学意义(P>0.05)。结论纳布啡联合瑞马唑仑可安全用于EMR术,围术期不良反应少,是无痛EMR术的良好选择。

Objective To investigate the safety and efficacy of Remimazolam combined with nalbuphine in painless endoscopic mucosal resection(EMR)of colorectal polyps.Methods A total of 100 patients who undergo painless colorectal polyp EMR were randomly divided into nalbuphine combined with remimazolam(NR)and nalbuphine combined with propofol(NP),with 50 patients in each group.The mean arterial pressure,heart rate and oxygen saturation were recorded after entry(T_(0)),1min after administration(T_(1)),1min at the beginning of surgery(T_(2)),3min(T_(3)),5min(T_(4)),and at the end of surgery(T_(5)).The frequency of application of vasoactive drugs,their operation time,consciousness vanishing time,recovery time,the times of supplementary sedation,dosage of incidence of nalbuphine,adverse reactions,The satisfaction of doctors and patients were compared.Results The mean arterial pressure of T_(1),T_(2),T_(3),T_(4) and T_(5) in the NR group was higher than that in the NP group(P<0.05),and the heart rate of T_(1) in the NR group was higher than that in the NP group(P<0.05).The incidence of respiratory depression,hypotension,injection pain,the recovery time and the frequency of application of vasoactive drugs in the NR group was lower than that in the NP group(P<0.05).The satisfaction of doctors in the NR group was higher than that in the NP group(P<0.05).There was no significant difference between the two groups in the operation time,oxygen saturation,the times of supplementary sedation,the dosage of incidence of nalbuphineincidence of dizziness,nausea and vomiting,and other adverse reactions(P>0.05).Conclusion Nalbuphine combined with remimazolam can be used safely in the EMR,has few perioperative adverse effects,and is a good choice for painless EMR.