甲苯磺酸瑞马唑仑或丙泊酚联合芬太尼在老年患者无痛胃镜诊疗中的应用效果  

Application effect of remimazolam tosilate or propofol combined with fentanylin the diagnosis and treatment of painless gastroscopy in elderly patients

作　　者：韦宁 廖艳英 韦珊珊[1] 韦登文[1] WEI Ning;LIAO Yanying;WEI Shanshan;WEI Dengwen(Department of Anesthesiology,Hechi Third People′s Hospital,Hechi 547000,Guangxi,China)

机构地区：[1]广西河池市第三人民医院麻醉科,广西河池市547000

出　　处：《广西医学》2023年第24期2938-2942,2953,共6页Guangxi Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20221153)。

摘　　要：目的 比较甲苯磺酸瑞马唑仑联合芬太尼或丙泊酚联合芬太尼在老年患者无痛胃镜诊疗中的应用效果。方法 将66例接受无痛胃镜诊疗的老年患者随机分为研究组和对照组,每组33例。在接受50μg芬太尼镇痛预处理的基础上,内镜进镜操作前分别给予研究组、对照组患者静脉泵注甲苯磺酸瑞马唑仑、丙泊酚,操作中根据需要追加相应药物。比较两组患者T_0(入室时)、T_(1)(给药后即刻)、T_(2)(给药后2 min)、T_(3)(给药后5 min)、T_(4)(给药后8 min)、T_(5)(给药后11 min)、T_(6)(给药后14 min)、T_7(清醒时)的心率、血压、呼吸频率、脉搏血氧饱和度(SpO_(2)),以及T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)的改良警觉/镇静(MOAA/S)量表评分。记录两组的镇静诱导时间、内镜操作时间、麻醉时间、镇静清醒时间,以及术中、术后不良反应发生情况。结果 两组的心率有随时间变化的趋势(P<0.05),但两组间差异无统计学意义(P>0.05)。两组的收缩压、舒张压、呼吸频率、SpO_(2)有随时间变化的趋势(P<0.05),且研究组T_(2)和T_(3)的收缩压、呼吸频率、SpO_(2),以及T_(2)的舒张压高于对照组(P<0.05)。研究组T_(2)的MOAA/S量表评分高于对照组(P<0.05),但在其余时间点两组的MOAA/S量表评分差异无统计学意义(P>0.05)。两组的麻醉时间、内镜操作时间、镇静诱导时间、镇静清醒时间差异无统计学意义(P>0.05)。研究组的低血压、呼吸抑制发生率低于对照组(P<0.05)。结论 甲苯磺酸瑞马唑仑或丙泊酚联合芬太尼应用于老年患者无痛胃镜检查均可发挥有效的镇静作用,但应用甲苯磺酸瑞马唑仑时患者的血流动力学更平稳,低血压、呼吸抑制发生率低,安全性更高。Objective To compare the application effect of remimazolam tosilate combined with fentanyl or propofol combined with fentanyl in the diagnosis and treatment of painless gastroscopy in elderly patients.Methods A total of 66 elderly patients who underwent painless gastroscopy for diagnosis and treatment were randomly assigned to study group or control group,with 33 cases in each group.On the basis of receiving 50μg fentanyl for analgesic preconditioning,intravenous pumping with remimazolam tosilate and propofol were given to patients in the study and control groups before endoscopic entry procedure,and corresponding drugs were added as needed during operation.The heart rate,blood pressure,respiratory frequency,pulse oxygen saturation(SpO 2)at T 0(entry of the endoscope room),T 1(immediately after administration),T 2(two minutes after administration),T 3(five minutes after administration),T 4(eight minutes after administration),T 5(11 minutes after administration),T 6(14 minutes after administration),and T 7(awake),as well as the Modified Observer′s Assessment of Alertness and Sedation(MOAA/S)scale score at T 1,T 2,T 3,T 4,T 5,and T 6 were compared between patients of the two groups.Time to sedation induction,endoscopic operation duration,anesthesia duration,sedation recovery time,and intra-and post-operative occurrence of adverse reactions were recorded in the two groups.Results There was a trend in heart rate over time in both groups(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).Systolic blood pressure,diastolic blood pressure,respiratory frequency,and SpO 2 of the two groups had a trend of change with time(P<0.05),and the study group yielded higher systolic blood pressure,respiratory frequency,and SpO 2 at T 2 and T 3,as well as higher diastolic blood pressure at T 2 as compared with the control group(P<0.05).The study group exhibited a higher score of MOAA/S scale at T 2 as compared with the control group(P<0.05),but no statistically significant difference in MOA

关 键 词：无痛胃镜 甲苯磺酸瑞马唑仑 丙泊酚 芬太尼 老年人 镇静效果 安全性 

分 类 号：R573.9[医药卫生—消化系统]