瑞马唑仑复合舒芬太尼用于肥胖患者无痛胃镜检查ED_(50)与ED_(95)的研究  

Study on ED_(50) and ED_(95) of remazolam combined with sufentanil in painless gastroscopy in obese patients

作　　者：岳明明 张洋 郭丽娜 李洪涛 赵同航[1] Yue Mingming;Zhang Yang;Guo Lina;Li Hongtao;Zhao Tonghang(Department of Anesthesiology,Liaocheng People′s Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院麻醉科,山东聊城252000

出　　处：《实用药物与临床》2023年第8期705-708,共4页Practical Pharmacy and Clinical Remedies

基　　金：山东省医学会舒适化医疗-麻醉优化专项资金项目(YXH2021ZX004)。

摘　　要：目的探索瑞马唑仑复合舒芬太尼用于肥胖患者无痛胃镜检查的半数有效量(ED_(50))和95%有效量(ED_(95))。方法选取2021年12月至2022年3月在聊城市人民医院内镜中心行无痛胃镜检查的肥胖患者50例,年龄18~65岁,体重指数>28 kg/m^(2),ASAⅢ级及以下。监测患者生命体征,顺序静脉给予0.1μg/kg舒芬太尼及试验剂量瑞马唑仑,待患者改良警觉/镇静评分(MOAA/S)≤1分后立即行胃镜检查,观察受试患者对胃镜检查的反应情况。设定瑞马唑仑初始剂量为0.21 mg/kg,若在内镜置入时及置入后2 min内出现呛咳、吞咽、体动等行为,影响检查操作判为无效,下一例患者增加剂量,有效时则降低剂量,瑞马唑仑增减浓度梯度为0.02 mg/kg。采用概率单位Probit回归分析法计算瑞马唑仑ED_(50)、ED_(95)及其95%CI。同时记录麻醉相关不良事件和恢复情况。结果50例肥胖患者均完成试验,其中有效26例,无效24例。肥胖患者胃镜检查镇静时,单次静脉注射瑞马唑仑的ED_(50)为0.203 mg/kg(95%CI:0.167~0.232 mg/kg),ED_(95)为0.291 mg/kg(95%CI:0.251~0.628 mg/kg)。麻醉期间出现低氧血症3例,低血压2例,呃逆3例,未见其他不良反应。结论瑞马唑仑在肥胖患者胃镜检查镇静时的ED_(50)为0.203 mg/kg,ED_(95)为0.291 mg/kg,不良反应发生率低。Objective To explore the 50%effective dose(ED_(50))and 95%effective dose(ED_(95))of remazolam combined with sufentanil in painless gastroscopy in obese patients.Methods Fifty obese patients aged 18~65 years,BMI>28 kg/m^(2)and ASA≤III,who underwent painless gastroscopy in the Endoscopy Center of Liaocheng People′s Hospital from December 2021 to March 2022 were selected.The vital signs of patients were monitored,and 0.1μg/kg sufentanil and test-dose rimazolam were given intraveneously in sequence.Gastroscopy was performed immediately after modified observe assessment of alertness/sedation(MOAA/S)score≤1 point,and the response of patients to gastroscopy was observed.The initial dose of rimazolam was set at 0.21 mg/kg.If there were cough,swallowing,body movement and other behaviors effecting the operation on and within 2 min after endoscopic implantation,the inspection operation was judged to be invalid,and then the dose was increased in the next patient.The dose was decreased when it was effective.The amount of increase or decrease was 0.02 mg/kg.The ED_(50),ED_(95) and 95%CI of remazolam were calculated by Probit regression analysis.Anesthesia-related adverse events and recovery were also recorded.Results All 50 obese patients completed the experiment,of which 26 were effective and 24 were ineffective.The ED_(50) and ED_(95) of remazolam were 0.203 mg/kg(95%CI:0.167~0.232 mg/kg)and 0.291 mg/kg(95%CI:0.251~0.628 mg/kg)for single intravenous injection of remazolam during gastroscopy sedation in obese patients.During anesthesia,there were 3 cases of hypoxemia,2 cases of hypotension and 3 cases of hiccup,but there were no other adverse reactions.Conclusion The ED_(50) and ED_(95) of remazolam are 0.203 mg/kg and 0.291 mg/kg,respectively.The incidence rate of adverse reactions is low.

关 键 词：瑞马唑仑 肥胖 无痛胃镜 半数有效量 95%有效量 

分 类 号：R969[医药卫生—药理学]