苯磺酸瑞马唑仑联合阿芬太尼麻醉在无痛胃肠镜检查中的应用

Application of remimazolam besylate combined with alfentanil anesthesia in painless gastrointestinal endoscopy examination

目的 探究苯磺酸瑞马唑仑联合阿芬太尼在无痛胃肠镜检查麻醉中的应用效果。方法 按随机数字表法将2021年10月至2023年10月郑州大学第一附属医院就诊的无痛胃肠镜受检者分为观察组和对照组,各80例。两组均行无痛胃肠镜检查,对照组接受依托咪酯联合阿芬太尼进行麻醉;观察组采用苯磺酸瑞马唑仑联合阿芬太尼进行麻醉。比较两组受检者麻醉临床指标和不良反应发生情况,并比较两组受检者给药前与给药后1 min、5 min时的血流动力学指标水平、Ramsay镇静评分,采用简易智能量表评定苏醒后10 min、20 min时的认知功能情况。结果 观察组的麻醉起效时间、苏醒时间、离室时间[(1.41±0.26) min、(6.07±1.56) min、(25.54±3.21) min]均低于对照组[(1.59±0.29) min、(8.89±2.34) min、(28.45±3.19) min],差异具有统计学意义(均P<0.05)。两组的不良反应发生情况差异无统计学意义(P>0.05)。在给药后1 min、5 min时,两组的血流动力学指标水平较给药前降低,但观察组[MAP(77.5±85.05) mm Hg (1 mm Hg≈0.133 kPa)、(78.97±5.08) mm Hg;血氧饱和度(Sp O_(2))(95.10±6.37)%、(96.19±6.09)%;心率(HR)(62.59±4.10)次·min^(-1)、(63.12±4.08)次·min^(-1)]高于对照组[MAP:(75.34±5.53) mm Hg、(76.71±5.13) mm Hg;SpO_(2)(93.01±6.28)、(94.15±6.13)%;HR(59.72±4.13)次·min^(-1)、(60.09±4.12)次·min^(-1)],差异具有统计学意义(均P<0.05)。在给药后1 min、5 min时,两组的Ramsay镇静评分较给药前提高,但观察组[(2.61±0.36)分、(2.35±0.36)分]低于对照组[(3.09±0.42)分、(2.83±0.43)分],差异具有统计学意义(均P<0.05)。在苏醒后10 min、20 min时,观察组的MMSE评分[(19.11±2.51)分、(25.56±2.46)分]高于对照组[(17.21±2.45)分、(23.01±2.73)分],差异具有统计学意义(均P<0.05)。结论 苯磺酸瑞马唑仑联合阿芬太尼在无痛胃肠镜检查麻醉中可以提供更好的镇静效果,具有起效快、苏醒快、血流动力学稳定等优点,且对认知功能的影响较小,不良反应发生率较低。

Objective To explore the application of remimazolam besylate combined with alfentanil in the anesthesia for painless gastrointestinal endoscopy examination.Methods According to the random number table method,160 patients receiving painless gastrointestinal endoscopy examination in the First Affiliated Hospital of Zhengzhou University from October 2021 to October 2023 were divided into the observation group and control group,with 80 in each group.The patients in the control group received etomidate combined with alfentanil for anesthesia,while those in the observation group were anesthetized with remimazolam besylate combined with alfentanil.The clinical indicators of anesthesia,occurrence of adverse reactions,and levels of hemodynamic indicators and sedation status(Ramsay sedation score)before administration and at 1 min and 5 min after administration were compared between the two groups.The cognitive function was assessed by Mini-Mental State Examination(MMSE)at 10 min and 20 min after recovery.Results The anesthesia onset time,recovery time and departure time were(1.41±0.26)min,(6.07±1.56)min and(25.54±3.21)min in the observation group,which were significantly shorter than those((1.59±0.29)min,(8.89±2.34)min and(28.45±3.19)min)in the control(P<0.05).There were no statistical differences in the adverse reactions between the two groups(P>0.05).At 1 min and 5 min after administration,the hemodynamic indicators in both groups were lower than before administration,but their levels in the observation group(MAP:(77.58±5.05)mmHg,(78.97±5.08)mmHg(1 mm Hg≈0.133 kPa);SpO_(2):(95.10±6.37)%,(96.19±6.09)%;HR:(62.59±4.10)times·min^(-1),(63.12±4.08)times·min^(-1))were higher than those of(MAP:(75.34±5.53)mmHg,(76.71±5.13)mmHg;SpO_(2):(93.01±6.28),(94.15±6.13)%;HR:(59.72±4.13)times·min^(-1),(60.09±4.12)times·min^(-1))in the control(P<0.05).The Ramsay sedation score in the two groups at 1 min and 5 min after administration was higher than that before administration,and the score in the observation group ((2.61±0.36) points, (2.35±0.36) points) was lower than that of ((3.09±0.42) points, (2.83±0.43) points) in the control (P<0.05). At 10 min and 20 min after recovery, the observation group had significantly higher MMSE score as compared with the control ((19.11±2.51) points vs (17.21±2.45) points, (25.56±2.46) points vs (23.01±2.73) points) (P<0.05). Conclusion Remimazolam besylate combined with alfentanil can provide good sedative effect during anesthesia for painless gastrointestinal endoscopy examination. It has the advantages of rapid onset, rapid recovery and stable hemodynamics. It can exert little effect on cognitive function and has low incidence of adverse reactions.