长期高危饮酒对复合阿芬太尼时瑞马唑仑用于无痛胃镜检查半数有效剂量的影响

Effect of long-term high-risk alcohol drinking on the median effective dose of remimazolam combined with alfentanil during painless gastroscopy

中文关键词: 饮酒  瑞马唑仑  阿芬太尼  胃镜检查  剂量-效应关系

英文关键词: Alcohol drinking  Remimazolam  Alfentanil  Gastroscopy  Dose-response relationship

中文摘要:

      
目的：探讨长期高危饮酒对复合阿芬太尼时瑞马唑仑用于无痛胃镜检查半数有效剂量(ED₅₀)的影响。
方法：选择择期行无痛胃镜检查术的男性患者46例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASA Ⅰ或Ⅱ级。根据患者饮酒情况分为两组：非饮酒组（n=24）和长期高危饮酒组（n=22）。采用Dixon序贯法确定无痛胃镜检查中复合阿芬太尼时瑞马唑仑的ED₅₀和95%有效剂量（ED₉₅）。麻醉诱导时缓慢静脉注射阿芬太尼5 μg/kg和瑞马唑仑，待患者睫毛反射消失、下颌松弛，改良警觉/镇静（MOAA/S）评分＜1分后进行胃镜检查。瑞马唑仑初始剂量0.2 mg/kg，剂量梯度为0.02 mg/kg。瑞马唑仑的剂量根据上一位患者的阳性或阴性反应而增加或减少一个剂量梯度。阳性反应定义：注射瑞马唑仑3 min后患者MOAA/S评分>1分，或进镜时出现呛咳、吞咽、体动等影响操作的反应。
结果：非饮酒组复合阿芬太尼时瑞马唑仑用于无痛胃镜检查的ED₅₀和ED₉₅分别为0.115 mg/kg（95%CI 0.104～0.126 mg/kg）和0.135 mg/kg（95%CI 0.125～0.189 mg/kg），长期高危饮酒组复合阿芬太尼时瑞马唑仑用于无痛胃镜检查的ED₅₀和ED₉₅分别为0.125 mg/kg（95%CI 0.112～0.137 mg/kg）和0.146 mg/kg（95%CI 0.135～0.216 mg/kg）。与非饮酒组比较，长期高危饮酒组瑞马唑仑的ED₅₀和ED₉₅均明显增加（P＜0.05）。
结论：复合阿芬太尼时瑞马唑仑用于长期高危饮酒患者的ED₅₀为0.125 mg/kg，长期高危饮酒可增加瑞马唑仑用于无痛胃镜检查的有效剂量。

英文摘要:

      
Objective: To explore the effect of long-term high-risk alcohol drinking on the median effective dose (ED₅₀) of remimazolam combined with alfentanil during painless gastroscopy.
Methods: Forty-six male patients undergoing elective painless gastroscopy, aged 18-64 years, BMI 18.5-28.0 kg/m², ASA physical status Ⅰ or Ⅱ, were divided into two groups according to the status of alcohol drinking: non-drinking group (n=24) and long-term high-risk drinking group (n=22). ED₅₀ and 95% effective dose (ED₉₅) of remimazolam were determined in the two groups by the Dixon's up-and-down method. Alfentanil 5 μg/kg and remimazolam were injected slowly during anesthesia induction. Gastroscopy was performed after the patient's eyelash reflex disappeared, jaw relaxion and the modified observer's assessment of alertness/sedation (MOAA/S) scale < 1. The initial dose of remimazolam was 0.2 mg/kg with a dose gradient of 0.02 mg/kg. The dose of remimazolam increased or decreased a dose gradient according on the positive or negative response of the previous patient. A positive response was defined as the MOAA/S scales still > 1 after 3 minutes of remimazolam injection, or coughing, swallowing, body movement and other affected the operation reactions during the inserting of the endoscope.
Results: The ED₅₀ and ED₉₅ of remimazolam combined with alfentanil during the painless gastroscopy were 0.115 mg/kg (95% CI 0.104-0.126 mg/kg) and 0.135 (95% CI 0.125-0.189 mg/kg) respectively in the non-drinking group, while the ED₅₀ and ED₉₅ of remimazolam combined with alfentanil during the painless gastroscopy were 0.125 mg/kg (95% CI 0.112-0.137 mg/kg) and 0.146 mg/kg (95% CI 0.135-0.216 mg/kg) respectively in the long-term high-risk drinking group. Compared with non-drinking group, the ED₅₀ and ED₉₅ were significantly higher in the long-term high-risk drinking group (P < 0.05).
Conclusion: The ED₅₀ of remimazolam combined with alfentanil during the painless gastroscopy is 0.125 mg/kg in the long-term high-risk drinking group. Long-term high-risk drinking can increase the median effective dose of remimazolam during the painless gastroscopy.