瑞马唑仑在老年早期喉癌患者超声引导喉上神经内侧支阻滞中的镇静效果观察

Observation of the sedative effect of remazolam on ultrasound-guided medial branch of superior laryngeal nerve block in elderly patients with early-stage laryngeal cancer

目的探讨瑞马唑仑在老年早期喉癌患者超声引导喉上神经内侧支阻滞中的镇静效果。方法选取2023年5—9月因早期喉癌就诊于首都医科大学附属北京同仁医院并行支撑喉镜二氧化碳激光切除术的患者60例,按随机数字表法分为咪达唑仑组和瑞马唑仑组,各30例。咪达唑仑组患者静脉注射0.08μg/kg舒芬太尼+0.02 mg/kg咪达唑仑镇静,瑞马唑仑组患者静脉注射相同剂量的舒芬太尼+0.04 mg/kg瑞马唑仑镇静。记录并比较2组患者镇静的成功率、镇静起效时间、恢复时间,2组患者不同时点的平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_(2))、镇静水平[采用改良警觉和镇静评分(MOAA/S)评定]及患者状态指数(PSI),患者和麻醉医师对镇静的满意度评分及患者神经阻滞期间心动过缓、低氧血症等不良事件发生率。结果瑞马唑仑组镇静成功率显著高于咪达唑仑组[83.3%(25/30)比53.3%(16/30)],镇静起效时间和恢复时间均明显短于咪达唑仑组,患者满意度和麻醉医师满意度评分明显高于咪达唑仑组,差异均有统计学意义(均P<0.05)。镇静期间2组MAP变化相似,瑞马唑仑组心率较咪达唑仑组平稳。瑞马唑仑组SpO_(2)在给药后2 min低于咪达唑仑组,给药后6、10、15 min均高于咪达唑仑组,差异均有统计学意义(均P<0.05)。给药后4、6、10 min瑞马唑仑组患者MOAA/S均低于咪达唑仑组,而PSI均高于咪达唑仑组,同时瑞马唑仑组患者给药后15 min PSI高于咪达唑仑组(均P<0.05)。瑞马唑仑组与咪达唑仑组神经阻滞镇静期间患者心动过缓、低氧血症、恶心呕吐发生率比较差异均无统计学意义(均P>0.05)。结论瑞马唑仑用于老年早期喉癌患者神经阻滞的镇静起效快,恢复迅速,且比咪达唑仑有更好的血流动力学稳定性,呼吸抑制轻,安全性好。

Objective To investigate the sedative effect of remazolam on ultrasound-guided medial branch of superior laryngeal nerve block in elderly patients.Methods A total of 60 patients with early-stage laryngeal cancer who were treated in Beijing Tongren Hospital,Capital Medical University from May to September 2023 and underwent laryngoscopic carbon dioxide laser resection were selected.They were divided into midazolam group and remazolam group according to the random number table method,with 30 cases in each group.The patients in the midazolam group were sedated with 0.08μg/kg sufentanil and 0.02 mg/kg midazolam,and the patients in the remazolam group were sedated with the same dose of sufentanil and 0.04 mg/kg remazolam.The success rate of sedation,sedation onset time,recovery time,mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_(2)),sedation level[evaluated using modified observer′s assessment of alert/sedation score(MOAA/S)],patient state index(PSI)at different time points,satisfaction score of patient and anesthesiologist with sedation,and the incidence of adverse events such as bradycardia and hypoxemia during the patient′s nerve block period were recorded and compared.Results The success rate of sedation in the remazolam group was significantly higher than that in the midazolam group[83.3%(25/30)vs 53.3%(16/30)],the onset time and recovery time of sedation were significantly shorter than those in midazolam group,and the satisfaction scores of patients and anesthesiologists with sedation were significantly higher than those in the midazolam group(all P<0.05).The changes of MAP were similar between the two groups during sedation,and the heart rate was more stable than that in the midazolam group.The SpO_(2) in the remazolam group was lower than that in the midazolam group at 2 min after administration,and those were higher than those in the midazolam group at 6,10,and 15 min after administration(all P<0.05).The MOAA/S of the remazolam group was lower than that of the midazolam group at 4,6 and 10 min after administration,while the PSI was higher than that of the midazolam group.At the same time,the PSI of the remazolam group was higher than that of the midazolam group at 15 min after administration(all P<0.05).There was no significant difference in the incidence of bradycardia,hypoxemia,nausea and vomiting between the remazolam group and the midazolam group during nerve block sedation(all P>0.05).Conclusion The sedation of remazolam for nerve block in elderly patients with early-stage laryngeal cancer has rapid onset and recovery,and it has better hemodynamic stability,less respiratory depression and better safety than midazolam.