内镜逆行性胰胆管造影术静脉麻醉诱导中苯磺酸瑞马唑仑与艾司氯胺酮最佳配比研究  

Optimal ratio of remazolam besylate to esketamine in the intravenous anesthesia patients undergoing endoscopic retrograde cholangiopancreatography

作　　者：王彦 胡志远[2] 苗振华 李俊青 刘红霞 吴梦淏 李佩 郭全周 闫立会 梁冬红 WANG Yan;HU Zhi-yuan;MIAO Zhen-hua;LI Jun-qing;LIU Hong-xia;WU Meng-hao;LI Pei;GUO Quang-zhou;YAN Li-hui;LIANG Dong-hong(Department of Anesthesiology,The Third Hospital of Xingtai,Hebei Xingtai 054000,China;Department of Pain,Xingtai People's Hospital,Hebei Xingtai054000,China)

机构地区：[1]邢台市第三医院麻醉科,河北邢台054000 [2]邢台市人民医院疼痛科,河北邢台054000

出　　处：《临床药物治疗杂志》2022年第12期76-81,共6页Clinical Medication Journal

摘　　要：目的探讨苯磺酸瑞马唑仑与艾司氯胺酮在经内镜逆行性胰胆管造影术(ERCP)手术静脉麻醉中的最佳配伍方案。方法选取2019年3月至2022年7月于邢台市第三医院准备行静脉全身麻醉诱导的ERCP的患者作为研究对象,并确定患者苯磺酸瑞马唑仑与艾司氯胺酮的静脉泵注起始给药速率,观察患者静脉泵注至警醒/镇静(OAA/S)评分≤1分的意识消失时间(TLOC),手术中观察脑电双频谱指数、无创动脉血压和心率的变化来调整苯磺酸瑞马唑仑与艾司氯胺酮的泵注给药速率。记录苯磺酸瑞马唑仑与艾司氯胺酮泵注后至OAA/S评分≥3分的意识恢复时间(TROC)。以术中95%患者药效指标满意、TLOC≤5 min、TROC≤10 min为目标利用响应曲面模型分析苯磺酸瑞马唑仑与艾司氯胺酮的相互作用并计算最佳配伍给药速率范围。结果共纳入120例患者,根据所选药物给药速率不同分为12组,每组10例响应曲面模型显示苯磺酸瑞马唑仑与艾司氯胺酮联合使用在ERCP患者静脉全身麻醉过程中具有显著协同作用,其最佳配伍给药速率范围:艾司氯胺酮为0.5、0.7、1.0、1.25 mg/(kg·h)时,对应的苯磺酸瑞马唑仑分别为0.5~0.8、0.45~0.65、0.35~0.50、0.2 mg/(kg·h)。结论苯磺酸瑞马唑仑与艾司氯胺酮镇静药效呈协同作用,在最佳配伍给药速率范围内可以为经ERCP的患者提供良好的麻醉效果,减少不良反应的发生。Objective To investigate the interaction between rimazolam benzoate and esketamine in the induction of intravenous anesthesia in patients undergoing transendoscopic retrograde cholangiopancreatography(ERCP)and optimize their dosing regimen.Methods Patients admitted from March 2019 to July 2022 who were prepared for ERCP induced by intravenous general anaesthesia in the Third Hospital of Xingtai were selected for the study.The starting dosing rate of intravenous pumping of rimazolam besylate and esketamine was determined,the time to loss of consciousness(TLOC)from intravenous pushing to an alertness/sedation(OAA/S)score≤1 was observed,and the intraoperative EEG dual spectrum changes in BIS,non-invasive arterial blood pressure and heart rate were used to adjust the pump dosing rate of remazolam benzoate and esketamine.The time to recovery of consciousness(TROC)after pumping of rimazolam besylate with esketamine to an OAA/S score of≥3 was recorded.The interaction between rimazolam besylate and esketamine was analyzed using response surface modelling and the optimal dosing rate range was calculated taking 95%of patients with a satisfactory intraoperative pharmacokinetic index,TLOC≤5 min and TROC≤10 min as targets.Results A total of 120 patients were included and divided into 12 groups according to the selected drug administration rates.Response surface models showed that the combination of rimazolam benzoate and esketamine had significant synergistic effects during intravenous general anesthesia in ERCP patients,and their optimal dosing rates ranged from 0.5,0.7,1.0,and 1.25 mg/(kg·h),corresponding to 0.5-0.8,0.45-0.65,0.35-0.50,and 0.2 mg/(kg·h)of rimazolam benzoate,respectively.Conclusion Ramazolam besylate has synergistic with the sedative effect with esketamine,and can provide good anesthesia and reduce the incidence of adverse effects in patients undergoing ERCP in the optimal dosing concentration range.

关 键 词：苯磺酸瑞马唑仑 艾司氯胺酮 内镜逆行性胰胆管造影术 响应曲面模型 麻醉 配伍给药速率 

分 类 号：R971.2[医药卫生—药品]