瑞马唑仑复合阿芬太尼用于老年患者无痛胃镜检查的效果和安全性  

Efficacy and safety of remimazolam combined with alfentanil in elderly patients undergoing painless gastroscopy

作　　者：张乐[1] 何龙[1] 赵二贤[1] 李莉[1] 李璐[1] 吕蕴琦[1] ZHANG Le;HE Long;ZHAO Erxian;LI Li;LI Lu;LYU Yunqi(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

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：《郑州大学学报（医学版）》2022年第5期689-693,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190205)。

摘　　要：目的:探讨瑞马唑仑复合阿芬太尼用于老年患者无痛胃镜检查的有效性和安全性。方法:选择行无痛胃镜检查的老年患者(≥65岁,ASAⅡ或Ⅲ级)186例,随机分为瑞马唑仑复合阿芬太尼组(RA组)和丙泊酚复合阿芬太尼组(PA组),每组93例。所有患者给予7μg/kg的阿芬太尼后,RA组给予0.2 mg/kg的瑞马唑仑,PA组给予1.5 mg/kg的丙泊酚。当改良警觉/镇静评分(MOAA/S评分)≤3分时开始胃镜检查。给予瑞马唑仑或者丙泊酚3 min MOAA/S评分>3分,则记为镇静失败。检查期间发生体动反应时,RA组单次追加瑞马唑仑2.5 mg/次,PA组追加丙泊酚0.5 mg/kg,维持MOAA/S≤3分。15 min内追加药物超过3次,更换镇静药物,记为镇静失败。记录镇静成功率、胃镜检查时间、苏醒时间,记录诱导前1~3 min、诱导后1、2、3、5 min及进镜时、检查结束时的血压、心率,记录术中体动、呛咳、呼吸抑制、低血压及术后24 h内不良反应发生情况,记录患者对内镜操作及检查的满意度。结果:RA组与PA组的镇静成功率分别为97.85%和100.00%,按非劣性效应边际值-10%比较,RA非劣于PA。RA组呼吸抑制及低血压的发生率低于PA组(P<0.05)。诱导后2、3 min RA组的平均动脉压下降幅度小于PA组,进镜时、诱导后2、3、5 min RA组的心率下降幅度小于PA组(P<0.05)。术中体动、呛咳、呼吸抑制及术后24 h恶心呕吐、头晕头痛、嗜睡乏力、腹胀腹痛等不良反应的发生率两组间差异无统计学意义(P>0.05)。RA组患者对内镜操作及检查的满意度高于PA组(P<0.001)。结论:瑞马唑仑复合阿芬太尼可能更适合ASAⅡ或Ⅲ级老年患者的无痛胃镜检查。Aim:To explore the efficacy and safety of remimazolam-alfentanil(RA)for painless gastroscopy in elderly patients.Methods:A total of 186 elderly patients(≥65 years,ASAⅡorⅢ)scheduled to undergo painless gastroscopy were randomized into two groups.Patients in the RA group(n=93)received 0.2 mg/kg initial dose of remimazolam following 7μg/kg dose of alfentanil.Patients in the propofol-alfentanil(PA)group(n=93)received 1.5 mg/kg initial dose of propofol combined with 7μg/kg dose of alfentanil.Gastroscopy was started when the modified alertness and sedation score(MOAA/S score)was less than or equal to 3 points.When the MOAA/S score was higher than 3 points at 3 min after the sedative drugs being administered,it was recorded as sedation failure.When the body movement occurred,a supplemental dose of 2.5 mg remimazolam or 0.5 mg/kg propofol was administered to maintain MOAA/S score less than or equal to 3 points during procedure,up to a maximum of three supplemental doses every 15 min.If the supplemental doses were insufficient to maintain adequate sedation within a 15-min window,changed sedation drug,and recorded as sedation failure.The success rate of sedation,procedure time,and time to full alert were recorded.Blood pressure and heart rate were recorded at the following time points:1-3 min before induction,1,2,3,5 min after induction,the insertion of gastroscopy,and the end of the procedure.The incidences of body movement,chocking,respiratory depression,hypotension during the procedure and adverse events in the postoperative 24 h were recorded.Patients′satisfaction was recorded.Results:The success rate of sedation was 97.85%in the RA group and 100.00%in the PA group,and RA was non-inferior to PA with the non-inferiority limit of-10%.The incidences of respiratory depression and hypotension were significantly lower in the RA group compared with the PA group(P<0.05).The mean artery pressure at 2 and 3 min after induction dropped less in the RA group compared with the PA group,and the heart rate at the insertion o

关 键 词：瑞马唑仑 阿芬太尼 老年患者 胃镜检查 

分 类 号：R614[医药卫生—麻醉学]