基于老年患者的瑞马唑仑消化内镜程序性镇静效果及安全性分析

Sedative effect and safety of remimazolam in digestive endoscopy procedures in elderly patients

目的评估老年患者进行消化内镜检查或治疗时使用瑞马唑仑的镇静效果及安全性。方法前瞻性选择2023年3月至2024年2月在暨南大学附属顺德医院内镜中心接受治疗的200例老年患者作为观察对象,按随机数表法分为瑞马唑仑组和丙泊酚组各100例。所有患者在治疗前均接受25~50μg芬太尼作为基础镇痛,丙泊酚组患者采用丙泊酚镇静,瑞马唑仑组患者采用瑞马唑仑组镇静。比较两组患者的镇静成功率及给药前(T1)、胃镜检查后1 min(T2)、3 min(T3)和清醒后5 min(T4)的平均动脉压(MAP)、心率(HR)和脉氧饱和度(SpO2)的变化;比较两组患者的镇静时间、胃镜操作时间、麻黄碱使用率及对麻醉的满意度,比较两组患者入室时、诊疗结束后苏醒15 min、30 min及60 min的简易精神状态量表(MMSE)评分及不良反应发生率。结果丙泊酚组和瑞马唑仑组患者的镇静成功率分别为95.00%、96.00%,差异无统计学意义(P>0.05),最终丙泊酚组入组95例,瑞马唑仑入组96例;瑞马唑仑组患者T2、T3时间点的MAP、HR和SpO2明显高于丙泊酚组,差异均有统计学意义(P<0.05);瑞马唑仑组患者的镇静时间、恢复时间分别为(19.83±3.69)min、(3.97±0.69)min,明显短于丙泊酚组的(22.08±3.20)min、(7.55±1.68)min,麻黄碱使用比例占4.17%,明显少于丙泊酚组的25.26%,差异均有统计学意义(P<0.05);瑞马唑仑组患者苏醒后15 min、30 min时的MMSE评分分别为(23.92±2.62)分、(24.46±2.89)分,明显高于丙泊酚组的(21.10±3.22)分、(22.43±2.85)分,差异均有统计学意义(P<0.05);瑞马唑仑组患者的体动反应、呼吸暂停、低血压、心动过缓、注射痛及头晕发生率分别为6.25%、7.29%、6.25%、3.13%、0、3.13%,明显低于丙泊酚组的21.05%、18.95%、29.47%、12.63%、69.47%、17.89%,差异均有统计学意义(P<0.05)。结论老年患者进行消化内镜程序性镇静时,与丙泊酚比较,瑞马唑仑的麻醉效果更好,更能稳定患者术中血流动力状态、促进术后早期恢复,且对患者术后认知功能影响较少。

Objective To evaluate the sedative effect and safety of remimazolam in elderly patients undergoing digestive endoscopy or therapy.Methods A total of 200 elderly patients who received treatment at the Endoscopy Center,Shunde Hospital Affiliated to Jinan University from March 2023 to February 2024 were prospectively selected and divided into remimazolam group and propofol group according to random number table method,with 100 patients in each group.All patients received 2550μg fentanyl as basic analgesia before treatment.Patients in the propofol group were sedated by propofol,and those in the remimazolam group were sedated by remimazolam.The success rate of sedation and the changes of mean arterial pressure(MAP),heart rate(HR),and pulse oxygen saturation(SpO2)before administration(T1),1 min(T2),and 3 min(T3)after gastroscopy,and 5 min(T4)after waking were compared between the two groups.The sedation time,gastroscopy operation time,ephedrine usage ratio,and the proportion of patients satisfied with anesthesia were also compared between the two groups,as well as the changes of Minimental State Examination(MMSE)scores at the time of admission and at 15 min,30 min and 60 min after recovery,and the incidence of adverse reactions.Results The success rate of sedation in the propofol group vs remimazolam group were 95.00%vs 96.00%(P>0.05).Finally,95 patients were enrolled in the propofol group and 96 patients were enrolled in the remimazolam group.MAP,HR,and SpO2 at T2 and T3 time points in remimazolam group were significantly higher than those in the propofol group(P<0.05).The sedation time and recovery time of the remimazolam group were(19.83±3.69)min and(3.97±0.69)min,which were significantly shorter than(22.08±3.20)min and(7.55±1.68)min of the propofol group;the proportion of patients with ephedrine use were 4.17%,which was significantly lower than 25.26%of the propofol group;the differences were statistically significant(P<0.05).The MMSE scores at 15 min and 30 min after recovery in the remimazolam group were(23.92±2.62)points and(24.46±2.89)points,which were significantly higher than(21.10±3.22)points and(22.43±2.85)points in the propofol group(P<0.05).The incidence of somokinetic reaction,apnea,hypotension,bradycardia,injection pain,and dizziness in remimazolam group were 6.25%,7.29%,6.25%,3.13%,0,and 3.13%,which were significantly lower than 21.05%,18.95%,29.47%,12.63%,69.47%,17.89%in the propofol group(P<0.05).Conclusion In elderly patients undergoing digestive endoscopy,remimazolam have a better anesthetic effect than propofol,which can better stabilize patients'intraoperative hemodynamic state and promote early postoperative recovery,and has less impact on patients'postoperative cognitive function.