瑞马唑仑复合舒芬太尼用于肝硬化食管胃静脉曲张老年患者内镜下硬化剂注射术麻醉效果的评价  

Evaluation of anesthetic effect of remazolam when combined with sufentanil in elderly patients with liver cirrhosis and esophageal and gastric varices undergoing endoscopic sclerotherapy

作　　者：黄栋 马亮 江泽宇 沈江[1] 徐青荣 Huang Dong;Ma Liang;Jiang Zeyu;Shen Jiang;Xu Qingrong(Department of Anesthesiology,The Third Affiliated Hospital of Soochow University,Changzhou 215006,China;Department of Gastroenterology,The Third Affiliated Hospital of Soochow University,Changzhou 215006,China)

机构地区：[1]苏州大学附属第三医院麻醉科,常州215006 [2]苏州大学附属第三医院消化科,常州215006

出　　处：《中华麻醉学杂志》2024年第5期579-583,共5页Chinese Journal of Anesthesiology

基　　金：常州市卫生健康青苗人才资助(CZQM2022004);常州市卫健委青年人才科技项目(QN202113);常州市应用基础研究指导性项目(CJ20239011);南京医科大学常州医学中心基础研究项目(CMCB202301)。

摘　　要：目的评价瑞马唑仑复合舒芬太尼用于肝硬化食管胃静脉曲张老年患者内镜下硬化剂注射术的麻醉效果。方法选取本院2022年3月至2023年9月行非气管插管全麻内镜下硬化剂注射术的肝硬化食管胃静脉曲张老年患者150例,性别不限,年龄65~80岁,BMI 18~24 kg/m^(2),ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=75):舒芬太尼复合丙泊酚组(PS组)和舒芬太尼复合瑞马唑仑组(RS组)。PS组静脉注射丙泊酚1~2 mg/kg及舒芬太尼0.1μg/kg麻醉诱导,静脉泵注丙泊酚4~10 mg·kg^(-1)·h^(-1)麻醉维持;RS组静脉注射瑞马唑仑0.1~0.2 mg/kg及舒芬太尼0.1μg/kg麻醉诱导,静脉泵注瑞马唑仑0.5~2 mg·kg^(-1)·h^(-1)麻醉维持。2组术中BIS值维持40~60。待患者意识消失(改良警觉/镇静评分≤1分)时置入内镜。2组患者均于食管黏膜下曲张静脉注射硬化剂聚桂醇注射液。记录意识消失时间和意识恢复时间、术中体动和心血管事件发生情况、术后低氧血症及呕心呕吐发生情况,采用视觉模拟评分法评价术者-患者满意度。结果与PS组比较,RS组术中心动过缓发生率、意识消失时间和意识恢复时间差异无统计学意义(P>0.05),术中低血压发生率降低,术后低氧血症及恶心呕吐发生率降低,术者及患者满意度评分升高(P<0.05)。2组患者术中均未见明显体动反应发生。结论舒芬太尼复合瑞马唑仑用于肝硬化食管胃静脉曲线老年患者内镜下硬化剂注射术的麻醉效果优于舒芬太尼复合丙泊酚。Objective To evaluate the anesthetic effect of remazolam when combined with sufentanil in elderly patients with liver cirrhosis and esophageal and gastric varices undergoing endoscopic sclerotherapy.Methods A total of 150 cirrhotic patients with liver cirrhosis and esophageal and gastric varices,regardless of gender,aged 65-80 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,who underwent endoscopic sclerotherapy under non-intubated general anesthesia from March 2022 to September 2023 in our hospital,were selected and divided into 2 groups(n=75 each)by a random number table method:sufentanil plus propofol group(PS group)and sufentanil plus remazolam group(RS group).Anesthesia was induced with intravenous propofol 1-2 mg/kg and sufentanil 0.1μg/kg and maintained by intravenous infusion of propofol 4-10 mg·kg^(-1)·h^(-1) in PS group.Anesthesia was induced with intravenous remimazolam 0.1-0.2 mg/kg and sufentanil 0.1μg/kg and was maintained with intravenous infusion of remimazolam 0.5-2.0 mg·kg^(-1)·h^(-1) in RS group.BIS values were maintained between 40 and 60 during operation in both groups.Endoscopy was placed when the patients lost consciousness(modified observer′s assessment of alertness/sedation score≤1).Sclerosing agent laurosinol injection was injected into esophageal submucosal varices in both groups.The time to loss of consciousness and recovery of consciousness,intraoperative body movement and cardiovascular events,and postoperative hypoxemia and nausea and vomiting were recorded.The operator-patient satisfaction was assessed by the visual analogue scale.Results Compared with PS group,no significant changes were found in the incidence of intraoperative bradycardia,time to loss of consciousness and time to recovery of consciousness(P>0.05),the incidence of intraoperative hypotension was significantly decreased,the incidence of postoperative hypoxemia and nausea and vomiting was decreased,and the satisfaction scores for operato

关 键 词：苯二氮[艹卓]类 舒芬太尼 老年人 肝硬化 食管和胃静脉曲张 硬化溶液 

分 类 号：R614[医药卫生—麻醉学]