小剂量瑞马唑仑复合依托咪酯或丙泊酚用于老年人胃肠镜检查的效果观察  

Efficacy of low-dose remimazolam combined with etomidate or propofol for gastrointestinal endoscopy in the elderly patients

作　　者：张建文[1] 杨智虎 渠明翠 马巧玲 邢飞 张卫[1] 邢娜[1] ZHANG Jianwen;YANG Zhihu;QU Mingcui;MA Qiaoling;XING Fei;ZHANG Wei;XING Na(Department of Anesthesiology,Pain and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450001,Henan province,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,河南郑州450052

出　　处：《世界临床药物》2023年第7期734-739,共6页World Clinical Drug

摘　　要：目的评价小剂量瑞马唑仑复合依托咪酯或丙泊酚用于老年人无痛胃肠镜的镇静效果。方法选择我院行无痛胃肠镜检查术患者129例,随机数字表法分为瑞马唑仑-依托咪酯组(RE组)、瑞马唑仑-丙泊酚组(RP组)及丙泊酚组(P组),每组43例。当患者改良警觉/镇静评分≤1分进镜。于诱导前(T0)、胃镜抵达咽腔时(T1)、给药后3 min(T2)和5 min(T3)记录血压(blood pressure,BP)、平均动脉压(mean arterial pressure,MAP)、心率及血氧饱和度,记录3组诱导时间、内镜检查时间、完全苏醒时间、离院时间以及不良事件发生情况。结果P组42例、RE、RP组各43例患者完成试验。与P组比较,RE、RP组的完全苏醒时间与离院时间均缩短(P<0.05);RE组T1、T2、T3的BP、MAP均较高,低血压、心动过缓和血管活性药物使用率均明显降低(P<0.05),RP组心动过缓、血管活性药物使用率均明显降低(P<0.05)。3组患者的呼吸抑制、低氧血症、头晕以及恶心呕吐等比较均无明显差异(P>0.05)。结论联合阿芬太尼4μg/kg时,瑞马唑仑0.05 mg/kg复合依托咪酯0.15 mg/kg对循环抑制轻微,恢复时间短,可安全应用于老年人群行无痛胃肠镜检查。Objective To evaluate the sedative effect of low-dose remimazolam combined with etomidate or propofol for painless gastrointestinal endoscopy in the elderly patients.Methods A total of 129 patients underwent painless gastrointestinal endoscopy in our hospital were selected and divided into remimazolam-etomidate group(group RE),remimazolam-propofol group(group RP)and propofol group(group P)by random number table method,with 43 cases in each group.When a modified observer's assessment of alertness/sedation score≤1,patients were admitted to the endoscope.Blood pressure(BP),mean arterial pressure(MAP),heart rate and pulse oxygen saturation were recorded before induction(T0),when gastroscope reached pharyngeal cavity(T1),3 min(T2)and 5 min(T3)after administration.The induction time,endoscopic examination time,recovery time,discharge time and the incidence of adverse events were recorded in the 3 groups.The cases of using cardiovascular drugs and the incidence of adverse reactions including hypoxia,hypotension,bradycardia,dizziness and postoperative nausea and vomiting(PONV)were recorded.Results Forty-two patients in group P,43 patients in group RE and RP completed the test.Compared with group P,the recovery time and discharge time were significantly shorter in group RE and RP(P<0.05).BP and MAP were higher in group RE at T1,T2,T3,and the utilization rate of hypotension,bradycardia and vasoactive drugs was significantly lower(P<0.05).The utilization rate of bradycardia and vasoactive drugs in group RP was significantly lower(P<0.05).There were no significant difference in the incidence of respiratory depression,hypoxia,dizziness,nausea and vomiting among the 3 groups(P>0.05).Conclusions When combined with affintanil 4μg/kg,remimazolam 0.05 mg/kg combined with etomidate 0.15 mg/kg has slight circulatory inhibition and short recovery time,which can be safely and effectively used for gastrointestinal endoscopy sedation in elderly patients.

关 键 词：老年人群 瑞马唑仑 依托咪酯 二异丙酚 胃肠镜检查 

分 类 号：R614[医药卫生—麻醉学]