瑞马唑仑艾司氯胺酮在老年患者经内镜逆行性胰胆管造影取石中的应用

Application of Remimazolam Tosilate Combined with Low-Dose Esketamine in Transendoscopic Retrograde Cholangiopancreatography of Elderly Patients

目的:探讨甲苯磺酸瑞马唑仑联合小剂量艾司氯胺酮在老年患者经内镜逆行性胰胆管造影取石(ERCP)中的安全性及有效性。方法:将行ERCP取石术的老年患者170例,随机分为A组(86例)和B组(84例)。A组采用甲苯磺酸瑞马唑仑联合小剂量艾司氯胺酮静脉麻醉,B组采用丙泊酚联合小剂量舒芬太尼静脉麻醉,比较两组患者麻醉不同时间点[入室(T0)、内镜进入喉咽部即刻(T1)、胆管造影时(T2)、取石时即刻(T3)、手术结束时(T4)、苏醒时(T5)]的生命体征指标,记录MOAA/S评分、不良反应。结果:两组T1~T4各时间点平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、动脉血氧分压(SPO 2)及水平较T0时明显下降(P<0.05),且A组患者T1~T4时MAP、HR、RR、SPO 2水平较B组更高(P<0.05)。A组患者术后麻醉苏醒后VAS评分为(1.73±0.33)分,低于B组的(2.15±0.38)分,MOAA/S评分为(4.03±0.67)分,高于B组的(3.19±0.53)分(t=7.700,9.052,均P<0.05)。A组麻醉苏醒时间及自主呼吸恢复时间为(7.40±2.12)min、(6.53±1.62)min,均早于B组的(11.57±3.26)min及(8.70±2.18)min(t=9.910,7.378,均P<0.05)。A组低血压、心动过缓等发生率均低于B组(P<0.05)。结论:相较于丙泊酚联合小剂量舒芬太尼,采用甲苯磺酸瑞马唑仑联合小剂量艾司氯胺酮在老年患者ERCP中的安全性及有效性更好,可提高苏醒质量,且产生的不良反应相对比较少。

Objective:To investigate the safety and efficacy of remimazolam tosilate combined with low-dose esketamine in transendoscopic retrograde cholangiopancreatography(ERCP)of elderly patients.Methods:One hundred and seventy elderly patients undergoing ERCP were randomly separated into group A(86 patients)and group B(84 patients).Group A was anesthetized with remimazolam tosilate combined with low-dose esketamine intravenously,and group B was anesthetized with propofol combined with low-dose sufentanil intravenously.The vital signs indexes at different time points of anesthesia[admission(T0),the moment of endoscopic entry into the laryngopharynx(T1),at cholangiography(T2),at the moment of lithotripsy(T3),at the end of the procedure(T4),and at the time of awakening(T5)]were compared between the two groups,and the MOAA/S scores and adverse reactions were recorded.Results:The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),partial pressure of arterial oxygen(SPO 2)and levels at each time point from T1 to T4 in both groups were greatly lower than those at T0(P<0.05),and the levels of MAP,HR,RR,and SPO 2 were higher in group A than in group B from T1 to T4(P<0.05).The VAS score of group A after anesthesia was(1.73±0.33),lower than that of group B(2.15±0.38),MOAA/S score was(4.03±0.67),higher than that of group B(3.19±0.53)(t=7.700,9.052,all P<0.05).Anesthesia recovery time and spontaneous respiration recovery time in group A were(7.40±2.12)min and(6.53±1.62)min,which were earlier than(11.57±3.26)min and(8.70±2.18)min in group B(t=9.910,7.378,all P<0.05).The incidences of hypotension and bradycardia in group A were lower than those in group B(P<0.05).Conclusion:Compared with propofol combined with low-dose sufentanil,the use of remimazolam tosilate combined with low-dose esketamine has a better safety and efficacy in ERCP in elderly patients,improves the quality of awakening,and produces relatively fewer adverse effects.