瑞马唑仑单独或联合瑞芬太尼用于清醒纤维支气管镜气管插管镇静的临床研究  

Clinical study of remimazolam alone or combined with remifentanil for sedation of tracheal intubation under awake fiberoptic bronchoscopy

作　　者：周晓瑞[1] 薛富善 王晟 李成文 Zhou Xiaorui;Xue Fushan;Wang Sheng;Li Chengwen(Anesthesia Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,北京100029 [2]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《中国医药》2024年第5期699-703,共5页China Medicine

基　　金：北京市自然科学基金(7242046);白求恩公益基金会2020围术期镇痛镇静研究项目(BCF-RF-WSQZTZJ-202011-012)。

摘　　要：目的探究瑞马唑仑单独或联合瑞芬太尼用于清醒纤维支气管镜气管插管(AFOI)镇静的临床效果。方法选择首都医科大学附属北京友谊医院2021年8月至2023年2月接受AFOI的择期手术患者60例作为研究对象,采用随机数字表法将患者分为瑞马唑仑单独组(RM组)及瑞马唑仑和瑞芬太尼联合组(RR组),每组各30例。RM组患者仅接受瑞马唑仑0.6 mg/(kg·h)持续输注。RR组患者接受瑞马唑仑0.6 mg/(kg·h)和瑞芬太尼0.05μg/(kg·min)联合输注。比较2组患者AFOI操作相关评价、不同时点[药物输注1 min(T_(1))和药物输注3 min(T_(2))、纤维支气管镜进入声门前(T_(3))、气管导管送入气管后(T_(4))]的镇静水平和血流动力学指标等情况。结果RR组患纤维支气管镜插管反应、咳嗽严重性和插管后耐受性评分、插管时间、知晓情况和再次接受AFOI意愿评分均低于/短于RM组,差异均有统计学意义(均P<0.001)。RR组T_(2)、T_(3)、T_(4)时的改良观察者警觉/镇静评分和脑电双频指数均低于RM组,差异均有统计学意义(均P<0.05)。RR组低氧血症和深度镇静的发生率均高于RM组[44.8%(13/29)比0(0/30),48.3%(14/29)比3.3%(1/30)],高血压和心动过速的发生率低于RM组[31.0%(9/29)比63.3%(19/30),34.5%(10/29)比73.3%(22/30)](均P<0.05)。结论单独应用瑞马唑仑可为AFOI提供有效镇静,且安全可靠;瑞马唑仑联合瑞芬太尼可提供更优的插管条件和舒适度,但可能增加呼吸抑制的风险。Objective To investigate the clinical effect of remimazolam alone or combined with remifentanil for sedation in awake fiberoptic bronchoscopic tracheal intubation(AFOI).Methods Sixty patients who underwent elective AFOI surgery in Beijing Friendship Hospital,Capital Medical University from August 2021 to February 2023 were selected as the research objects.The patients were divided into remimazolam alone group(RM group)and remimazolam combined with remifentanil group(RR group)by random number table method,with 30 cases in each group.Patients in the RM group received only a continuous infusion of remimazolam 0.6 mg/(kg·h).RR group received remimazolam 0.6 mg/(kg·h)and remifentanil 0.05μg/(kg·min)combined infusion.AFOI operation-related evaluation,sedation level and hemodynamic indexes at different time points[drug infusion at 1 min(T_(1))and 3 min(T_(2)),before fiberoptic bronchoscope entering the glottis(T_(3)),and after tracheal tube entering the trachea(T_(4))]were compared between the two groups.Results The response to fiberoptic bronchoscopy intubation,cough severity and post-intubation tolerance score,intubation time,awareness and willingness to accept AFOI score in RR group were lower/shorter than those in RM group(all P<0.001).The Modified Observer′s Assessment of Alertness/Sedation score and bispectral index at T_(2),T_(3)and T_(4)in RR group were lower than those in RM group(all P<0.05).The incidence of hypoxemia and deep sedation was higher and the incidence of hypertension and tachycardia was lower in the RR group than in the RM group[44.8%(13/29)vs 0(0/30),48.3%(14/29)vs 3.3%(1/30),31.0%(9/29)vs 63.3%(19/30),34.5%(10/29)vs 73.3%(22/30)](all P<0.05).Conclusions Remimazolam alone can provide effective sedation for AFOI and is safe and reliable.Remimazolam combined with remifentanil can provide better intubation conditions and comfort,but may increase the risk of respiratory depression.

关 键 词：镇静 清醒纤维支气管镜气管插管 瑞马唑仑 瑞芬太尼 

分 类 号：R473.72[医药卫生—护理学]