不同剂量瑞马唑仑复合舒芬太尼在无痛胃镜检查术中的比较

Comparison of different doses of remimazolam combined with sufentanil in painless gastroscopy

中文关键词: 瑞马唑仑  舒芬太尼  无痛胃镜  镇静

英文关键词: Remimazolam  Sufentanil  Painless gastroscopy  Sedation

中文摘要:

      
目的 探讨不同剂量瑞马唑仑复合舒芬太尼用于无痛胃镜检查术的有效性及适宜剂量。
方法 选择2021年8—11月拟行无痛胃镜检查术患者160例，男84例，女76例，年龄18～64岁，BMI 18～30 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为四组：丙泊酚2 mg/kg组（P组）、瑞马唑仑0.2 mg/kg组（R1组）、瑞马唑仑0.3 mg/kg组（R2组）和瑞马唑仑0.4 mg/kg组（R3组），每组40例。P组、R1组、R2组和R3组静脉注射舒芬太尼0.1 μg/kg行镇痛预处理后，60 s内分别静脉注射丙泊酚2 mg/kg、瑞马唑仑0.2、0.3和0.4 mg/kg，改良警觉/镇静（MOAA/S）评分≤2分时即开始胃镜操作。记录首次镇静成功率、胃镜检查时间、苏醒时间、离院时间。记录术中低氧血症、低血压、体动、呛咳、呃逆、注射痛和术后恶心呕吐等不良反应发生情况。记录患者和内镜医师对麻醉的满意度。
结果 与P组比较，R1组首次镇静成功率、低氧血症、低血压、注射痛发生率和内镜医师满意率明显降低，苏醒时间和离院时间明显缩短，体动和呛咳发生率明显升高（P＜0.05）；R2组低氧血症、低血压和注射痛发生率明显降低（P＜0.05）；R3组苏醒时间与离院时间明显延长，低氧血症、低血压、注射痛发生率和内镜医师满意率明显降低（P＜0.05）。与R1组比较，R2组首次镇静成功率和内镜医师满意率明显升高，苏醒时间和离院时间明显延长，体动和呛咳发生率明显降低（P＜0.05）。与R2组比较，R3组苏醒时间和离院时间明显延长（P＜0.05）。
结论 瑞马唑仑0.3 mg/kg复合舒芬太尼0.1 μg/kg用于无痛胃镜检查术镇静成功率高，对呼吸和循环影响小，效果最佳。

英文摘要:

      
Objective To investigate the efficacy and appropriate dose of remimazolam combined with sufentanil in painless gastroscopy.
Methods A total of 160 patients from August 2021 to November 2021 scheduled for painless gastroscopy, 84 males and 76 females, aged 18-64 years, BMI 18-30 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly divided into four groups using random number table method: propofol 2 mg/kg group (group P), remimazolam 0.2 mg/kg group (group R1), remimazolam 0.3 mg/kg group (group R2), and remimazolam 0.4 mg/kg group (group R3), 40 patients in each group. Patients were pretreated with sufentanil 0.1 μg/kg intravenously, propofol 2 mg/kg and different dose of remimazolam 0.2, 0.3, and 0.4 mg/kg were injected within 60 seconds in groups P, R1, R2, and R3, respectively. Gastroscopy was performed when the modified alert/sedation (MOAA/S) score ≤ 2. The rate of firstly successful sedation, operation time, awaken time, time of discharge, the occurrence of intraoperative hypoxemia, hypotension, motor reaction, cough, hiccup, injection pain, and postoperative nausea and vomiting, patient and endoscopic physician satisfaction with anesthesia were recorded.
Results Compared with group P, rate of firstly successful sedation, incidence of hypoxemia, hypotension, injection pain, and rate of endoscopic physician satisfaction were significantly decreased, awaken time and time of discharge were significantly shortened, incidence of body movement and choking were significantly increased in group R1 (P < 0.05), incidence of hypoxemia, hypotension, and injection pain were significantly decreased in group R2 (P < 0.05), awaken time and time of discharge were significantly prolonged, incidence of hypoxemia, hypotension, injection pain, and rate of endoscopic physician satisfaction were significantly decreased in group R3 (P < 0.05). Compared with group R1, rate of firstly successful sedation and endoscopic physician satisfaction were significantly increased, awaken time and time of discharge were significantly prolonged, incidence of body movement and choking were significantly decreased in group R2 (P < 0.05). Compared with group R2, awaken time and time of discharge were significantly prolonged in group R3 (P < 0.05).
Conclusion The combination of remimazolam 0.3 mg/kg and sufentanil 0.1 μg/kg using in painless gastroscopy has a high sedation success rate and has little effect on respiration and circulation, which can be safely used in painless gastroscopy.