瑞马唑仑-氟马西尼方案对内窥镜逆行胰胆管造影术患者苏醒情况的影响  

Effect of remimazolam-flumazenil regimen on emergence of patients undergoing endoscopic retrograde cholangiopancreatography

作　　者：肖艳英[1] 朱蓉[1] 戴茹萍[1] 张燕玲[1] 傅迪[2] Xiao Yanying;Zhu Rong;Dai Ruping;Zhang Yanling;Fu Di(Department of Anesthesiology,The Second Xiangya Hospital of Central South University,Changsha 410011)

机构地区：[1]中南大学湘雅二医院麻醉科,长沙410011 [2]中南大学湘雅医院麻醉科,长沙410078

出　　处：《中华麻醉学杂志》2024年第4期433-437,共5页Chinese Journal of Anesthesiology

基　　金：湖南省自然科学基金(2018JJ3769);湖南省卫生健康委员会科研计划课题(202104112304)。

摘　　要：目的评价瑞马唑仑-氟马西尼方案对内窥镜逆行胰胆管造影(ERCP)术患者苏醒情况的影响。方法选择拟在全身麻醉下行ERCP术患者84例,性别不限,年龄18~78岁,BMI 18~30 kg/m2,ASA分级Ⅰ-Ⅲ级。采用随机数字表法分为2组(n=42):瑞马唑仑-氟马西尼组(RF组)和丙泊酚组(P组)。麻醉诱导:RF组静脉注射瑞马唑仑0.2 mg/kg和瑞芬太尼2μg/kg;P组静脉注射丙泊酚1.5 mg/kg和瑞芬太尼2μg/kg。麻醉维持:RF组静脉泵注瑞马唑仑0.5~2.0 mg·kg^(-1)·h^(-1)和瑞芬太尼0.1~0.2μg·kg^(-1)·min^(-1),P组静脉泵注丙泊酚2~8 mg·kg^(-1)·h^(-1)和瑞芬太尼0.1~0.2μg·kg^(-1)·min^(-1),维持BIS值40~60。术毕时RF组静脉注射氟马西尼0.2 mg,P组静脉注射等体积生理盐水。记录苏醒时间、喉罩拔除时间、术后复苏室停留时间、苏醒期不良反应发生情况、患者满意度评分、内镜医师满意度评分和术后24 h时15项恢复质量量表评分。结果与P组比较,RF组苏醒时间、喉罩拔除时间和PACU停留时间缩短,欣快感发生率降低(P<0.05)。2组躁动、头晕、恶心呕吐和再镇静发生率、患者满意度评分、内镜医师满意度评分和术后24 h时15项恢复质量量表评分比较差异无统计学意义(P>0.05)。结论与丙泊酚相比,瑞马唑仑-氟马西尼方案用于ERCP术患者可缩短苏醒时间,提高苏醒质量。Objective To evaluate the effect of the remimazolam-flumazenil regimen on the emergence of patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Eighty-four American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients,regardless of gender,aged 18-78 yr,with body mass index of 18-30 kg/m2,undergoing elective ERCP under general anesthesia,were allocated into 2 groups(n=42 each)using a random number table method:remimazolam-flumazenil group(RF group)and propofol group(P group).Anesthesia was induced as follows:Remimazolam 0.2 mg/kg and remifentanil 2μg/kg were intravenously injected in RF group,and propofol 1.5 mg/kg and remifentanil 2μg/kg were intravenously injected in P group.Anesthesia was maintained as follows:Remimazolam was intravenously infused at a rate of 0.5-2.0 mg·kg^(-1)·h^(-1) and remifentanil at a rate of 0.1-0.2μg·kg^(-1)·min^(-1) in RF group,and propofol was intravenously infused at a rate of 2-8 mg·kg^(-1)·h^(-1) and remifentanil at a rate of 0.1-0.2μg·kg^(-1)·min^(-1) in P group,maintaining a bispectral index value of 40-60.At the end of procedure,RF group received an intravenous injection of flumazenil at 0.2 mg,while P group received an equal volume of normal saline.The emergence time,laryngeal mask removal time,duration of post-anesthesia care unit stay,development of adverse events during the emergence period,patients′satisfaction scores,endoscopists′satisfaction scores,and 15-item Quality of Recovery scale scores at 24 h after operation were recorded.Results Compared to P group,the emergence time,laryngeal mask removal time and duration of post-anesthesia care unit stay were significantly shortened,and the incidence of euphoria was decreased in RF group(P<0.05).There were no statistically significant differences between the two groups in the incidence of agitation,dizziness,nausea/vomiting,and re-sedation,patients′satisfaction scores,endoscopists′satisfaction scores,and 15-item Quality of Recovery scale scores at 24 h after

关 键 词：苯二氮类 氟马西尼 二异丙酚 门诊外科手术 胰胆管造影术 内窥镜逆行 麻醉恢复期 

分 类 号：R614[医药卫生—麻醉学]