甲苯磺酸瑞马唑仑复合艾司氯胺酮在肝硬化患者无痛内镜下静脉曲张套扎术中的安全性和有效性

Safety and efficacy of remimazolam tosilate combined with esketamine in painless endoscopic variceal ligation in patients with liver cirrhosis

目的探讨甲苯磺酸瑞马唑仑复合艾司氯胺酮在肝硬化患者无痛内镜下静脉曲张套扎术(EVL)中的安全性和有效性。方法选择2021年8月至2022年7月在聊城市人民医院内镜中心接受无痛EVL的肝硬化患者90例,采用随机数字表法平均分为3组,每组30例。A组:甲苯磺酸瑞马唑仑0.2 mg/kg诱导后以1 mg/(kg·h)维持;B组:丙泊酚1~2 mg/kg诱导后以3~8 mg/(kg·h)维持;C组:丙泊酚1~2 mg/(kg·h)诱导后以1.2%~2%七氟醚维持。三组均予艾司氯胺酮0.15 mg/(kg·h)输注复合麻醉。记录患者术前基本资料、围术期血流动力学、操作成功率、术中麻醉药物用量、血管活性药物使用例数、手术时间、麻醉时间、拔管时间、麻醉恢复室(PACU)停留时间、出血量、输液量、患者疼痛评分、患者和内镜医生满意度评分和相关不良反应。结果A组患者拔管时间[(5.50±1.78)min]、麻醉恢复室停留时间[(15.27±2.18)min]均较B组[(7.27±1.96)min、(18.63±2.66)min]、C组[(7.77±1.28)min、(19.33±1.45)min]缩短(P<0.05)。虽然B组操作期间需要血管活性药物患者数略多于其他两组,但差异无统计学意义(P>0.05)。与B组和C组相比,A组患者舒张压在T2(插管后)和T5(插管后15 min)时间点升高(P<0.05);心率在T7(拔管后5 min)时升高,而在T_(9)(拔管后15 min)时降低(P<0.05)。三组患者的内镜医师满意度、术后早期疼痛评分及不良反应发生率比较,差异均无统计学意义(P>0.05)。结论甲苯磺酸瑞马唑仑复合艾司氯胺酮麻醉方案可以安全有效地用于肝硬化患者EVL,可缩短拔管时间和术后PACU停留时间,加快内镜室周转速度。

Objective To investigate the safety and efficacy of remimazolam tosilate combined with esketamine in painless endoscopic variceal ligation(EVL)in patients with liver cirrhosis.Methods Totally 90 patients with liver cirrhosis who underwent painless EVL in Liaocheng People's Hospital from August 2021 to July 2022 were chosen,and they were randomly divided into 3 groups,with 30 cases in each group.Group A:anesthesia was induced by remimazolam 0.2 mg/kg and maintained at 1 mg/(kg·h);group B:anesthesia was induced by propofol 1~2 mg/kg and maintained at 3~8 mg/(kg·h);group C:anesthesia was induced by propofol 1~2 mg/kg and maintained by 1.2%~2%sevoflurane.All the patients were given esketamine infusion[0.15 mg/(kg·h)]for compound anesthesia.Patients'baseline data,perioperative hemodynamics,success rate of operation,intraoperative anesthetic dosage,the number of patients using vasoactive drugs,operation time,anesthesia time,extubation time,time of PACU stay,bleeding volume,infusion volume,pain scores,satisfaction scores of patients and endoscopists and related adverse reactions were re‐corded.Results The extubation time[(5.50±1.78)min]and time of PACU stay[(15.27±2.18)min]of group A were shorter than those of group B[(7.27±1.96)min and(18.63±2.66)min]and group C[(7.77±1.28)min and(19.33±1.45)min](P<0.05).Although the number of patients who needed vasoactive drugs during the operation in group B was slightly more than the other groups,but there was no significant difference(P>0.05).Compared with group B and C,DBP in group A was higher at T2(immediately after intubation)and T5(15 min after intubation)(P<0.05);HR in group A increased at T7(5 min after extubation)and decreased at T_(9)(15 min after extubation)(P<0.05).There was no significant difference in the satisfaction degree of patients and endoscopists,early postoperative pain score or incidence of adverse reactions among the three groups(P>0.05).Conclusion Remimazolam tosilate combined with esketamine can be safely and effectively used in EVL in patients with liver cirrhosis,which can shorten the time of extubation and PACU stay,and speed up the turnover of endoscopy room.