苯磺酸瑞马唑仑联合舒芬太尼在老年病人无痛胃肠镜检查中的应用

Clinical application of the remimazolam benzenesulfonate combined with sufentanil in elderly patients undergoing painless gastroenteroscopy

目的:探讨苯磺酸瑞马唑仑联合舒芬太尼应用于老年病人无痛胃肠镜检查的麻醉效果及不良反应。方法:采用随机对照的研究方法,将500例行无痛胃肠镜手术的老年病人,随机分为丙泊酚组(P组)和瑞马唑仑组(R组),各250例。麻醉诱导采用舒芬太尼0.05μg/kg,2 min后P组静脉注射丙泊酚1.5 mg/kg,R组静脉注射瑞马唑仑0.2 mg/kg,待病人OAA/S≤2分时进行内镜检查操作。术中维持P组静脉泵注丙泊酚5 mg·kg^(-1)·h^(-1),R组静脉泵注瑞马唑仑0.5 mg·kg^(-1)·h^(-1),操作结束后停止给药。检查过程中如发生呛咳或体动反应,P组追加丙泊酚0.5 mg/kg,R组追加瑞马唑仑0.05 mg/kg。比较2组病人入室(T_(0))、诱导后2 min(T_(1))、胃镜开始后1 min(T_(2))、胃镜结束时(T_(3))、肠镜开始后1 min(T_(4))、肠镜结束时(T_(5))、病人清醒时(T_(6))、离开PACU时(T_(7))血流动力学指标,比较2组胃肠镜检查时间、镇静起效时间、镇静成功率、苏醒时间、麻醉药物用量和呼吸抑制及不良反应发生情况。结果:P组T_(1)~T_(4)时收缩压、T_(1)时舒张压、T_(1)~T_(4)时平均动脉压、T_(1)~T_(5)时心率、T_(1)~T_(6)时血氧饱和度均较R组降低(P<0.05~P<0.01),T_(1)~T_(7)时无创呼气末二氧化碳分压均较R组升高(P<0.05~P<0.01)。2组胃肠镜操作时间和镇静成功率差异均无统计学意义(P>0.05);与P组相比,R组镇静起效时间明显延长,苏醒时间明显缩短,麻醉药物用量明显降低(P<0.01)。R组体发生率明显高于P组(P<0.01),呼吸抑制和呃逆、低血压、心动过缓、注射痛、恶心呕吐发生率均低于P组(P<0.05~P<0.01)。结论:瑞马唑仑联合舒芬太尼可安全有效地应用于老年无痛胃肠镜手术,且术后苏醒快,呼吸抑制等不良反应发生率低。

Objective:To investigate the anaesthetic effects and adverse effects of remimazolam benzenesulfonate combined with sufentanil in elderly patients undergoing painless gastroenteroscopy.Methods:Using the randomized numerical table method,500 elderly patients undergoing painless gastroenteroscopy were randomly divided into the propofol group(group P)and remazolam group(group R)(250 cases each group).After 2 min of anesthesia induction with 0.05μg/kg of sufentanil,the 1.5 mg/kg of propofol was injected intravenously into the group P,and the 0.2 mg/kg of remazolam was injected intravenously into group R.Endoscopic examination was performed when OAA/S was≤2.The 5 mg·kg^(-1)·h^(-1) of propofol was injected intravenously in group P,and the 0.5 mg·kg^(-1)·h^(-1) of remazolam was injected intravenously in group R for anaesthesia maintenance,and the administration stopped after the procedure.If coughing or body motion reaction occurred during the examination,the 0.5 mg/kg propofol was added to group P,and the 0.05 mg/kg remazolam was added to group R.The hemodynamic indexes between two groups were compared at entering the room(T_(0)),2 min after induction(T_(1)),1 min after gastroscopy(T_(2)),the end of gastroscopy(T3),1 min after colonoscopy(T_(4)),at the end of colonoscopy(T_(5)),patients awaking(T_(6))and lefting PACU(T_(7)).The time of gastroenteroscopy examination,effective time of sedation,successful rate of sedation,recovery time,dosage of anesthetic drugs,respiratory depression and adverse reactions were compared between two groups.Results:The systolic blood pressure at T_(1)-T_(4),diastolic blood pressure at T1,mean arterial pressure at T_(1)-T_(4),heart rate at T_(1)-T_(5),and blood oxygen saturation at T_(1)-T_(6) in the group P were lower than those in group R(P<0.05 to P<0.01),and the noninvasive end-expiratory carbon dioxide pressure at T_(1)-T_(7) in the group P were higher than those in group R(P<0.05 to P<0.01).There was no statistical significance in the operation time of gastroenteroscopy and successful rate of sedation between two groups(P>0.05).Compared with the group P,the onset time of sedation was significantly prolonged,the recovery time was significantly shortened,and the dosage of anesthetic drugs was significantly decreased in group R(P<0.01).The incidence of body in the group R was significantly higher than that in group P(P<0.01),and the incidence rates of respiratory depression and hiccup,hypotension,bradycardia,injection pain,nausea and vomiting in the group R were lower than those in group P(P<0.05 to P<0.01).Conclusions:Remazolam combined with sufentanil can be safely and effectively used in elderly patients undergoing painless gastroenteroscopy,and the postoperative recovery is fast and the incidence of adverse reactions such as respiratory depression is low.