甲苯磺酸瑞马唑仑联合瑞芬太尼用于宫腔镜手术的临床效果  

Clinical effect of remimazolam tosilate combined with remifentanil in hysteroscopic surgery

作　　者：江维 曹娟 薛洲亚 钱斌 JIANG Wei;CAO Juan;XUE Zhouya(Department of Anesthesiology,First People's Hospital of Yancheng,Yancheng 224006,CHINA)

机构地区：[1]盐城市第一人民医院麻醉科,江苏224006

出　　处：《江苏医药》2023年第7期677-680,共4页Jiangsu Medical Journal

基　　金：江苏省高校省级重点实验室开放课题(KSJ1702)。

摘　　要：目的观察甲苯磺酸瑞马唑仑联合瑞芬太尼在宫腔镜手术中的麻醉效果。方法拟行静脉全身麻醉下宫腔镜检查及手术的患者80例,随机均分为甲苯磺酸瑞马唑仑联合瑞芬太尼组(R组)和丙泊酚联合瑞芬太尼组(P组)。两组患者手术开始前5min泵注瑞芬太尼3μg·kg^(-1)·h^(-1)。P组静脉注射丙泊酚1.5mg/kg至改良警觉/镇静评分(mOAA/S)为0分时,然后以4mg·kg^(-1)·h^(-1)泵注维持;R组静脉注射甲苯磺酸瑞马唑仑0.15mg/kg至mOAA/S为0分时,以1mg·kg^(-1)·h^(-1)泵注维持。记录两组患者麻醉前(T0)、麻醉后意识消失(T1)、扩张宫颈(T2)、手术开始5min(T3)以及苏醒(T4)时患者MAP、HR和SpO_(2),采用VAS疼痛评分评估苏醒时和苏醒后30min时患者疼痛程度,观察患者苏醒时间、术中呼吸抑制以及术后不良反应发生情况。结果与T0时相比,两组T1~T3时MAP和HR降低(P<0.05);与P组相比,R组T1~T3时MAP增加(P<0.05),T1时HR增加(P<0.05),T3时SpO_(2)增加(P<0.05)。两组患者术后苏醒时间比较差异无统计学意义(P>0.05);R组苏醒时和苏醒后30min时VAS疼痛评分低于P组(P<0.05)。R组呼吸抑制和注射痛发生率低于P组(P<0.05)。结论甲苯磺酸瑞马唑仑联合瑞芬太尼在宫腔镜手术患者的麻醉中可以产生良好的镇静、镇痛作用,对呼吸循环影响较小,注射痛发生率较低,且不良反应轻微。Objective To observe the anesthetic effect of remimazolam tosilate combined with remifentanil in the hysteroscopic surgery.Methods Eighty patients undergoing hysteroscopy under general anesthesia were equally randomized into two groups of R and P.Remifentanil 3μg·kg^(-1).h^(-1) was infused started on 5 minutes before operation in both groups.When modified observer's assessment of alertness/sedation(mOAA/S)ran up to zero after propofol 1.5 mg/kg was intravenously injected,propofol 4 mg·kg^(-1)·h^(-1) was infused thenafter in group P.When mOAA/S ran up to zero after remimazolam tosilate 0.15 mg/kg was intravenously injected,remimazolam tosilate 1 mg·kg^(-1)·h^(-1)was infused thenafter in group R.The MAP,HR and SpO_(2) were recorded before anesthesia(T0),consciousness disappearing during anesthesia induction(T1),at the moment of cervical dilatation(T2),at 5 minutes after the beginning of operation(T3)and immediately after awakening(T4).The pain degree immediately and at 30 minutes after awakening was evaluated by VAS pain score.The awakening time and the incidences of intraoperative respiratory depression and adverse responses were observed.Results Compared with TO,MAP and HR were decreased at T1-T3 in groups of R and P(P<0.05).Compared with group P,MAP was increased at T1-T3,HR was increased at T1,and SpO_(2) was increased at T3 in group R(P<0.05).There was no statistical difference in the awakening time after operation between groups of R and P(P>0.05).VAS pain scores immediately and 30 minutes after awakening in group R were less than those in group P(P<0.05).The incidences of respiratory depression and injection pain in group R were lower than those in group P(P<0.05).Conclusion Remimazolam tosilate combined with remifentanil has a good sedation and analgesia effect in the patients undergoing hysteroscopic surgery with less impact on respiration and circulation,lower incidence of injection pain and milder adverse responses.

关 键 词：甲苯磺酸瑞马唑仑 瑞芬太尼 宫腔镜 

分 类 号：R614[医药卫生—麻醉学]