艾司氯胺酮复合瑞马唑仑对胃肠镜检查老年患者术中去氧饱和及低血压的影响

Effect of esketamine combined with remimazolam on oxygen desaturation and hypotension in elderly patients undergoing gastroenteroscopy

目的评估艾司氯胺酮复合瑞马唑仑用于胃肠镜检查老年患者的麻醉效果以及对去氧饱和、血流动力学的影响。方法纳入行胃肠镜检查的老年患者160例,随机均分纳入瑞马唑仑组(R组)或艾司氯胺酮复合瑞马唑仑组(E+R组)。2组患者均静脉注射舒芬太尼0.1μg·kg^(-1)和瑞马唑仑0.2 mg·kg^(-1)进行麻醉诱导,E+R组在此基础上静脉注射艾司氯胺酮0.25 mg·kg^(-1)。主要结局指标为检查过程中去氧饱和、低血压发生情况。次要结局指标包括检查过程中血流动力学指标、补救镇静情况、意识消失时间、意识恢复时间、麻醉恢复室(PACU)停留时间。记录2组患者麻醉诱导前(T_(0))、麻醉诱导后即刻(T_(1))、置入胃镜后即刻(T_(2))、置入肠镜后即刻(T_(3))、手术结束即刻(T_(4))的平均动脉压(MAP)和心率(HR)。PACU内指标包括恶心呕吐、头晕/头痛、苏醒延迟、苏醒期躁动发生情况以及患者满意度。结果E+R组和R组最终分别纳入78例和80例患者。E+R组去氧饱和、低血压发生率与补救镇静≥2次的比例显著低于R组(P<0.05)。E+R组意识消失时间、意识恢复时间及PACU停留时间显著短于R组(P<0.05)。E+R组T_(1)~T_(3)时点MAP、HR均显著高于R组(P<0.05)。R组T_(2)、T_(3)时点的MAP、HR显著高于T_(1)时点(P<0.05),而E+R组T_(2)、T_(3)时点的MAP、HR与T_(1)时点比较无显著差异(P>0.05)。2组患者PACU内恶心呕吐、头晕/头痛、苏醒延迟、苏醒期躁动发生率以及满意度评分的比较均无显著差异(P>0.05)。结论与瑞马唑仑相比,艾司氯胺酮复合瑞马唑仑能够缩短胃肠镜检查老年患者苏醒时间,降低去氧饱和、低血压发生率,有助于维持血流动力学稳定且不增加苏醒期不良反应。

AIM To evaluate the anesthetic effect of esketamine combined with remimazolam in elderly patients undergoing gastroenteroscopy,as well as the influence on oxygen desaturation saturation and hemodynamics.METHODS A total of 160 elderly patients scheduled to undergo gastroenteroscopy in our hospital from September 2021 to October 2023 were included,and randomly equally divided into remimazolam group(R group)or esketamine combined remimazolam group(E+R group).Both two groups received intravenous injection of sufentanil 0.1μg·kg^(-1)and remimazolam 0.2 mg·kg^(-1)for anesthesia induction.The E+R group additionally was given intravenous esketamine 0.25 mg·kg^(-1).The primary outcomes during the examination include occurrence of desaturation and hypotension.Secondary outcomes include hemodynamic parameters during the examination,rescue sedation,time to loss of consciousness,time to recovery of consciousness,and PACU stay time.The MAP and HR are recorded at different time points:before anesthesia induction(T_(0)),immediately after anesthesia induction(T_(1)),immediately after the placement of gastroscopy(T_(2)),immediately after the placement of colonoscopy(T_(3)),and immediately after the surgery(T_(4)).The PACU outcome include nausea/vomiting,dizziness/headache,delayed awakening,emergence agitation,and patient satisfaction scores.RESULTS There were 78 and 80 patients included eventually in the E+R group and the R group,respectively.The rates of deoxygenation saturation,hypotension and remedial sedation 2 times in the E+R group were significantly lower than those in the R group(P<0.05).The loss time of consciousness,recovery time of consciousness and PACU residence time in the E+R group were significantly shorter than those in the R group(P<0.05).MAP and HR of T_(1)-T_(3)time points in the E+R group were significantly higher than those in the R group(P<0.05).The MAP and HR of T_(2)and T_(3)were significantly higher than those of T_(1)in the R group(P<0.05),but there was no significant difference between MAP and HR of T_(2)or T_(3)and those of T_(1)in the E+R group(P>0.05).There were no significant differences in PACU nausea and vomiting,dizziness/headache,delayed recovery,emergence agitation and satisfaction scores between the two groups(P>0.05).CONCLUSION Compared with remimazolam,esketamine combined with remimazolam can shorten the recovery time,reduce the incidence of desaturation and hypotension in elderly patients undergoing gastroenteroscopy,and contribute to maintain hemodynamic stability without increasing adverse reactions during recovery.