瑞马唑仑联合丙泊酚对无痛胃肠镜检查患者血流动力学水平及应激反应的影响

Effect of remimazolam combined with propofol on hemodynamic level and stress response in patients undergoing painless gastroscopy examination

目的探究瑞马唑仑联合丙泊酚对无痛胃肠镜检查患者血流动力学水平及应激反应的影响。方法选取2023年7月至2024年3月西北大学第一医院收治的87例行无痛胃肠镜检查的患者为研究对象,采用随机数字表法将研究对象分为对照组(43例)和观察组(44例),对照组给予右美托咪定联合丙泊酚进行麻醉,观察组给予瑞马唑仑联合丙泊酚进行麻醉。比较分析两组患者的麻醉效果、麻醉前后的血流动力学水平[心率(HR)、平均动脉压(MAP)]和应激反应指标[皮质醇(Cor)、血管紧张素Ⅱ(Ang-Ⅱ)、醛固酮(ALD)水平]、麻醉后不同时间点的镇静和镇痛效果[Ramsay镇静评分、视觉模拟评分法(VAS)评分]以及检查过程中的不良反应发生情况。结果观察组患者的麻醉起效时间、苏醒时间均短于对照组,差异均有统计学意义(P<0.05)。与麻醉诱导前比较,两组患者肠镜通过肝区时的HR、MAP均下降,但观察组高于对照组,差异均有统计学意义(P<0.05)。与麻醉前比较,两组患者麻醉后1 h的Cor、Ang-Ⅱ、ALD水平均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。麻醉后1 h,观察组患者的Ramsay镇静评分高于对照组,VAS评分低于对照组,差异均有统计学意义(P<0.05)。观察组患者检查过程中的不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论瑞马唑仑联合丙泊酚可维持无痛胃肠镜检查患者的血流动力学水平稳定,显著减轻患者的应激反应,具有较好的镇静、镇痛效果,且安全性较好。

Objective To explore the effect of remimazolam combined with propofol on hemodynamic level and stress response in patients undergoing painless gastroscopy examination.Method 87 patients undergoing painless gastroscopy examination admitted to the Northwest University First Hospital from July 2023 to March 2024 were selected as the study objects.They were divided into control group(43 cases)and observation group(44 cases)by random number table method.The control group was anesthetized with dexmedetomidine combined with propofol,and the observation group was anesthetized with remimazolam combined with propofol.Anesthesia effect,hemodynamic level(HR,MAP)and stress response index(Cor,Ang-Ⅱ,ALD)before and after anesthesia,sedation and analgesia effect(Ramsay sedation score,VAS score)at different time points after anesthesia,and the occurrence of adverse reactions during the examination were compared between the two groups.Result The onset time and recovery time of anesthesia in observation group were shorter than those in control group,with statistical signifi cance(P<0.05).Compared with before anesthesia induction,HR and MAP in two groups decreased when colonoscopy was passed through the liver area,but the observation group was higher than the control group,with statistical signifi cance(P<0.05).Compared with before anesthesia,the levels of Cor,Ang-Ⅱand ALD in two groups were increased 1 h after anesthesia,but the observation group was lower than the control group,with statistical significance(P<0.05).At 1 h after anesthesia,Ramsay sedation score in observation group was higher than control group,and VAS score was lower than control group,with statistical significance(P<0.05).The total incidence of adverse reactions in observation group was lower than that in control group,with statistical significance(P<0.05).Conclusion Remimazolam combined with propofol can maintain the stable hemodynamic level of patients undergoing painless gastroscopy examination,and signifi cantly reduce the stress response,and have good sedative and analgesic effects,with good safety.