瑞马唑仑在儿童无痛胃镜检查中的应用  

Application of remimazolam in children during painless gastroscopy

作　　者：拾翠翠 孙剑[2] 张玉凤[2] SHI Cuicui;SUN Jian;ZHANG Yufeng(Medical College of Yangzhou University,Yangzhou Jiangsu 225009;Department of Anesthesiology,Huai’an Maternal and Child Health Hospital,Huai’an Jiangsu 223002,China)

机构地区：[1]扬州大学医学院,江苏扬州225009 [2]淮安市妇幼保健院麻醉科,江苏淮安223002

出　　处：《临床与病理杂志》2021年第12期2918-2922,共5页Journal of Clinical and Pathological Research

摘　　要：目的:评价瑞马唑仑在儿童无痛胃镜检查中的安全性及有效性。方法:选择淮安市妇幼保健院行无痛胃镜检查患儿60例,性别不限,年龄1~6岁,体重9~28 kg,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ或Ⅱ级,随机分丙泊酚组(P组)与瑞马唑仑组(R组),每组各30例。所有患儿胃镜检查开始前3min单次静脉注射芬太尼1μg/kg,P组静脉注射丙泊酚2mg/kg,R组静脉注射瑞马唑仑0.2mg/kg。待患儿改良警觉/镇静量表(Modified Observer’s Assessment of Alertness/Sedation Scale,MOAA/S)评分达3分时开始进行胃镜操作。若第1次静脉注射丙泊酚或瑞马唑仑后不能达到有效镇静深度,1min后行补救镇静,P组追加丙泊酚0.5m g/k g,R组追加瑞马唑仑0.0 5mg/kg,累计追加次数最多为5次。开始胃镜检查后,根据患儿情况,给予丙泊酚0.5mg/(kg·次)或瑞马唑仑0.05/(kg·次),维持一定镇静深度。记录患儿MOAA/S镇静评分、镇静开始时间、苏醒时间、 SpO_(2)、HR、血压、补救镇静给药情况及镇静成功率,同时记录患儿低血压、心动过缓、低氧血症、喉痉挛、注射痛等不良反应发生情况。结果:与P组相比,R组镇静起效时间明显延长,但苏醒时间明显缩短(P<0.05);两组患儿镇静成功率均为100%;R组补救镇静率显著高于P组(90%vs60%,P<0.05),且R组平均药物追加次数显著高于P组(P<0.01);在不良反应方面,R组低血压及注射痛的发生率显著减少(P<0.05)。结论:瑞马唑仑可安全有效地用于儿童无痛胃镜检查,但最佳剂量还需进一步探索。与丙泊酚相比,不良反应发生率显著减少,镇静成功率均为100%。Objective:To evaluate the safety and efficacy of remimazolam in children during painless gastroscopy.Methods:A total of 60 children were selected and randomly divided into a propofol group(group P,n=30) and a remimazolam group(group R,n=30),with no gender limitation,age 1–6 years old,weight 9–28 kg,American Society of Anesthesiologists Score Ⅰ or Ⅱ.All children were intravenously injected with fentanyl 1 μg/kg 3 minutes before the painless gastroscopy examination,and then a dose of propofol 2 mg/kg or remimazolam 0.2 mg/kg was injected intravenously in group P or group R.Gastroscopy was started when the Modified Observer’s Assessment of Alertness/Sedation Scale(MOAA/S) reaching 3 points.In case of insufficient sedation after the first intravenous injection of propofol or remimazolam,remedial sedation was performed 1 minute later with propofol 0.5 mg/kg or remimazolam 0.05 mg/kg.Children could receive a maximum of 5 remimazolam or propofol doses.After starting gastroscopy,the depth of sedation was maintained by administering propofol 0.5 mg/kg or remimazolam 0.05 mg/kg each time.The MOAA/S score,sedation onset time,recovery time,SpO_(2),HR,blood pressure,the rate of rescue sedation,and successful sedation were all recorded.At the same time,we recorded the incidence of hypotension,bradycardia,hypoxemia,laryngeal spasm,injection pain and other adverse reactions.Results:Compared with group P,the onset time of sedation in group R was significantly longer,but the recovery time was significantly shorter(P<0.05).The rate of successful sedation in both groups was 100%.The remedial sedation rate of group R was significantly higher than that of group P(90% vs 60%,P<0.05),and the number of additional medications in group R was significantly higher than that of group P(P<0.01).In terms of adverse reactions,the incidence of hypotension and injection pain in group R was significantly decreased(P<0.05).Conclusion:Remimazolam is safe and effective for children during painless gastroscopy,and we need further explore abo

关 键 词：无痛胃镜检查 镇静 丙泊酚 瑞马唑仑 不良反应 

分 类 号：R726.1[医药卫生—儿科]