肥胖因素对复合阿芬太尼时瑞马唑仑用于无痛胃镜检查术量效关系的影响  

Effect of obesity on dose-effect relationship of remimazolam when combined with alfentanil in painless gastroscopy

作　　者：李平乐[1] 杨智虎 邢飞 张庆丽 袁雅卓 邢娜[1] Li Pingle;Yang Zhihu;Xing Fei;Zhang Qingli;Yuan Yazhuo;Xing Na(Department of Anesthesiology,Pain and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,郑州450052

出　　处：《中华麻醉学杂志》2022年第6期712-715,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价肥胖因素对复合阿芬太尼时瑞马唑仑用于无痛胃镜检查术量效关系的影响。方法拟行无痛胃镜检查术患者,ASA分级Ⅰ或Ⅱ级,性别不限,年龄18~64岁,按BMI分为2组,正常组(BMI 19~24 kg/m^(2))和肥胖组(BMI≥28 kg/m^(2))。所有患者均给予阿芬太尼5μg/kg复合瑞马唑仑静脉麻醉,采用改良Dixon序贯法进行试验,瑞马唑仑起始剂量为0.25 mg/kg,剂量梯度为0.05 mg/kg,若进镜时及检查开始2 min内患者出现吞咽、呛咳、体动等影响检查操作的反应为阳性,下一例患者增加1个剂量梯度,否则视为阴性,下一例患者降低1个剂量梯度,重复此过程直至出现7个转折。采用Probit法计算瑞马唑仑的半数有效剂量(ED_(50))、95%有效剂量(ED_(95))及其95%置信区间(CI)。结果正常组26例,肥胖组18例。正常组ED_(50)及其95%CI为0.196(0.087~0.274)mg/kg,ED_(95)及其95%CI为0.322(0.256~1.397)mg/kg。肥胖组ED_(50)及其95%CI为0.125(0.102~0.148)mg/kg,ED_(95)及其95%CI为0.161(0.141~0.242)mg/kg,肥胖组ED_(50)和ED_(95)均低于正常组(P<0.001)。结论复合阿芬太尼5μg/kg时,肥胖因素增加瑞马唑仑用于无痛胃镜检查术患者的效力。Objective To evaluate the effect of obesity on the dose-effect relationship of remimazolam when combined with alfentanil in painless gastroscopy.Methods American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,scheduled for elective painless gastroscopy,aged 18-64 yr,were divided into 2 groups according to the body mass index(BMI):normal(BMI 19-24 kg/m^(2))group and obese(BMI≥28 kg/m^(2))group.Alfentanil 5μg/kg combined with remimazolam was given intravenously in all the patients,and the dose of remimazolam was determined by the modified Dixon′s up-and-down method.The initial dose of remimazolam was 0.25 mg/kg,and each time the dose was increased or decreased by 0.05 mg/kg based on the sedative effect.The response was defined as positive when the responses that affected the operation of examination developed during insertion of the gastroscope and within the first 2 min of examination such as swallowing,bucking or body movement.This process was repeated until the seventh intersection occurred.The 50%effective dose(ED_(50)),95%effective dose(ED_(95)),and 95%confidence interval(CI)of remimazolam were calculated by probit method.Results There were 26 patients in normal group and 18 patients in obese group.The ED_(50)(95%CI)of remimazolam was 0.196(0.087-0.274)mg/kg,and the ED_(95)(95%CI)was 0.322(0.256-1.397)mg/kg in normal group.The ED_(50)(95%CI)of remimazolam was 0.125(0.102-0.148)mg/kg,and the ED_(95)(95%CI)was 0.161(0.141-0.242)mg/kg in obese group.The ED_(50) and ED_(95) were significantly lower in obese group than in normal group(P<0.001).Conclusions Obesity increases the potency of remimazolam when combined with alfentanil 5μg/kg in the patients undergoing painless gastroscopy.

关 键 词：肥胖症 阿芬太尼 催眠药和镇静药 胃镜检查 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]