不同剂量瑞马唑仑对宫腔镜检查期间异丙酚需求的影响

Effect of different doses of remimazolam on propofol requirements during hysteroscopy

目的 探究不同负荷剂量瑞马唑仑对宫腔镜检查期间异丙酚需求的影响。方法 将2023年4月至2023年12月安徽医科大学附属阜阳医院收治的90例接受宫腔镜检查的妇女纳入本次前瞻性研究,按照随机数字表法将其分为对照组(n=21)、低剂量组(n=23)、中剂量组(n=23)和高剂量组(n=23)。对照组、低剂量组、中剂量组和高剂量组分别静脉注射0、0.1、0.15和0.2 mg/kg瑞马唑仑,然后推注舒芬太尼0.15μg/kg,靶控输注异丙酚,每组首位患者的CeProp设置为3.5μg/mL,使用序贯法确定各组异丙酚的半数有效浓度(EC50);比较各组意识丧失(T1)、宫颈扩张完成即刻(T2)、异丙酚停药(T3)和意识恢复即刻(T4)时的CeProp值,围术期的各指标[异丙酚总用量、麻醉苏醒时间、麻醉后监测治疗室(PACU)停留时间、术后30 min视觉模拟评分法(VAS)评分和住院时间]和不良反应发生情况。结果 4组抑制宫颈扩张反应的异丙酚EC50分别为3.51(3.25~3.82)、2.05(1.85~2.30)、1.83(1.55~2.10)、1.42(1.27~1.58)μg/mL,低、中、高剂量组的异丙酚EC50均明显低于对照组,差异均有统计学意义(P<0.05),且低、中、高剂量组的异丙酚EC50差异无统计学意义(P>0.05)。低、中、高剂量组在T1、T2、T3时的CeProp均明显低于对照组,中、高剂量组在T4时的CeProp均明显低于对照组,差异均有统计学意义(P<0.05),且低、中、高剂量组在T1、T2、T3、T4时的CeProp差异无统计学意义(P>0.05)。4组异丙酚总用量分别为(6.08±1.27)、(4.21±0.96)、(3.89±0.73)、(2.92±1.01) mg/kg,低、中、高剂量组的异丙酚总用量均显著高于对照组,且高剂量组的异丙酚总用量明显低于低剂量组和中剂量组,差异均有统计学意义(P<0.05)。4组的麻醉苏醒时间、PACU停留时间、术后30 min VAS评分、住院时间和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 对于接受宫腔镜检查的妇女,0.1~0.2 mg/kg剂量瑞马唑仑可降低抑制宫颈扩张的异丙酚EC50和异丙酚的总需求量。

Objective To explore effect of different doses of remimazolam on propofol requirements during hysteroscopy.Methods Ninety women undergoing hysteroscopy at Fuyang Hospital of Anhui Medical University from April 2023 to December 2023 were included in this prospective study and were divided into the control group(n=21),the low-dose group(n=23),the middle-lose group(n=23)and the high-low group(n=23)according to the random number table method.The control group,the low-dose group,the middle-lose group and the high-low group were treated with intravenous injection of 0,0.1,0.15,and 0.2 mg/kg remimazolam,followed by intravenous infusion of sufentanil 0.15μg/kg and a target-controlled propofol infusion.The initial target Ceprop was 3.5μg/mL,and the concentration for 50%of maximal effect(EC 50)of propofol in each group was determined using sequential method.Ceprop at loss of consciousness(T 1),immediately after cervical dilation(T 2),discontinuation of propofol(T 3)and regain consciousness(T 4),perioperative indicators[the total dosage of propofol,anesthesia recovery time,post-anesthesia care unit(PACU)stay time,visual analogue scale(VAS)score at 30 min after operation and hospitalization time],as well as the occurrence of adverse reactions were compared.Results The EC 50 of propofol for suppressing response to cervical dilation in the four groups were 3.51(3.25-3.82),2.05(1.85-2.30),1.83(1.55-2.10),and 1.42(1.27-1.58)μg/mL,respectively.The EC 50 of propofol in the low-dose,the middle-dose and the high-dose groups were dramatically lower than that in the control group,the differences were statistically significant(P<0.05),and the difference in EC 50 of propofol between middle-dose and high-dose groups was not statistically significant(P>0.05).The Ceprop at T 1,T 2 and T 3 in low-dose,middle-dose and high-dose groups were dramatically lower than those in the control group,while the Ceprop of middle-dose and high-dose groups at T 4 was dramatically lower than that of the control group,the differences were statistically significant(P<0.05),but there were no statistically significant differences in Ceprop among the low-dose,middle-dose and high-dose groups at T 1,T 2,T 3,and T 4(P>0.05).The total dosages of propofol in the four groups were(6.08±1.27),(4.21±0.96),(3.89±0.73)and(2.92±1.01)mg/kg,respectively.The total dosages of propofol in the low-dose,middle-dose and high-dose groups were dramatically higher than that in the control group,and the total dosage of propofol in the high-dose group was dramatically lower than those in the low-dose and middle-dose groups,the differences were statistically significant(P<0.05).There were no statistically significant differences in the anesthesia recovery time,length of PACU stay,inpatient days,VAS score at 30 minutes,and incidence of adverse reactions in the four groups(P>0.05).Conclusion For women undergoing hysteroscopy,remimazolam at doses from 0.1 to 0.2 mg/kg can reduce the EC 50 of propofol inhibiting response to cervical dilation and the total propofol requirement.