性别因素对阿芬太尼复合苯磺酸瑞马唑仑用于无痛胃镜检查术量效关系的影响  

Effect of gender on dose-effect relationship of remimazolam combined with alfentanil in painless gastroscopy

作　　者：詹勇 李俊青 袁浩 ZHAN Yong;LI Junqing;YUAN Hao(Department of Anesthesiology,Fuyang Hospital,Anhui Medical University,Fuyang 236000,China)

机构地区：[1]安徽医科大学附属阜阳医院麻醉科,阜阳安徽236000

出　　处：《沈阳医学院学报》2024年第1期53-57,共5页Journal of Shenyang Medical College

摘　　要：目的:评价性别因素对阿芬太尼复合苯磺酸瑞马唑仑用于无痛胃镜检查术量效关系的影响。方法:选择拟行择期无痛胃镜检查的受检者,年龄18~60岁,体重指数19~24 kg/m^(2),ASAⅠ、Ⅱ级。根据性别分为男性组和女性组,2组首例受检者均接受阿芬太尼5μg/kg和苯磺酸瑞马唑仑0.2 mg/kg,2 min后置入消化内镜,胃镜置入及检查过程中受检者出现体动、呛咳、吞咽、皱眉等动作定义为阳性反应。采用Dixon改良序贯法,以0.05 mg/kg为一个剂量梯度,根据受检者是否出现阳性反应调整下一例受检者的用药剂量,若出现阳性反应,则下一例给药剂量增加一级梯度,反之剂量降一级,以次类推,阳性反应-阴性反应交叉点出现第7次时终止研究。采用Probit法计算苯磺酸瑞马唑仑抑制胃镜置入反应的半数有效剂量(ED50)、95%有效剂量(ED95)及其95%可信区间(CI)。结果:共纳入受检者46例,其中男性组、女性组各纳入23例完成试验。2组受检者一般资料比较差异无统计学意义,男性组阿芬太尼联合苯磺酸瑞马唑仑抑制胃镜置入反应的ED50为0.193 mg/kg(95%CI:0.145~0.286),ED95为0.293 mg/kg(95%CI:0.237~0.903);女性组阿芬太尼联合苯磺酸瑞马唑仑抑制胃镜置入反应的ED50为0.215 mg/kg(95%CI:0.155~0.293),ED95为0.316 mg/kg(95%CI:0.261~0.968);男性组阿芬太尼联合苯磺酸瑞马唑仑抑制胃镜置入反应的ED50、ED95均低于女性组(P<0.05)。结论:复合5μg/kg的阿芬太尼时,苯磺酸瑞马唑仑抑制男性受检者胃镜置入反应的效力强于女性。Objective:To evaluate the effect of gender on dose-effect relationship of remimazolam combined with alfentanil in painless gastroscopy.Methods:Subjects who planned to undergo elective painless gastroscopy,aged 18-60 years old,body mass index 19-24 kg/m^(2),American Society of Anesthesiologists physical statusⅠorⅡ,were enrolled.They were divided into male group and female group.The first subject in both groups received afentanil 5μg/kg and remimazolam 0.2 mg/kg,and was implanted into a gastroscope 2 minutes later.Positive reactions were defined as body movement,coughing,swallowing and frowning during gastroscopy placement and examination.Remimazolam 0.05 mg/kg was used as a dose gradient by using modified Dixon's up-and-down method.The dose of the next subject was adjusted according to whether the subject had a positive reaction.If there was a positive reaction,the dose of the next subject was increased by one level of gradient,otherwise,the dose was decreased by one level of gradient,and so on.The process was terminated at the seventh intersection point of positive-negative reaction.And 50% effective dose(ED50),95% effective dose(ED95)and 95% confidence interval(CI)of remimazolam for inhibiting gastroscopic implantation reaction was calculated by Probit method.Results:A total of 46 subjects were included,with 23 subjects in each group.There was no significant difference in general data between the two groups.The ED50 of afentanil combined with remimazolam was 0.193 mg/kg(95%CI:0.145-0.286),and the ED95 was 0.293 mg/kg(95%CI:0.237-0.903)in male group.The ED50 of afentanil combined with remimazolam was 0.215 mg/kg(95%CI:0.155-0.293),and the ED95 was 0.316 mg/kg(95%CI:0.261-0.968)in female group.The ED50 and ED95 inhibitory effect of afentanil combined with remimazolam in male group were significantly lower than those in female group(P<0.05).Conclusion:When combined with 5μg/kg of afentanil,remimazolam is more effective in inhibiting responses to gastroscopy inserting in male subjects than in female subjects.

关 键 词：性别因素 阿芬太尼 瑞马唑仑 半数有效量 

分 类 号：R614.2[医药卫生—麻醉学]