瑞马唑仑联合利多卡因喷喉在胃镜诊疗中的半数有效剂量  

The median effective dose of remazolam for painless gastroscopy when combined with lidocaine

作　　者：任莉 梁就庆 梁根强 REN Li;LIANG Jiu-Qing;LIANG Gen-Qiang(Department of Anesthesiology,Zhuhai People’s Hospital Zhuhai Medical College Affiliated to Jinan University,Zhuhai 519000,Guangdong,China)

机构地区：[1]珠海市人民医院暨南大学附属珠海医学院麻醉科,广东珠海519000

出　　处：《吉林医学》2024年第11期2708-2712,共5页Jilin Medical Journal

基　　金：广东省自然科学基金资助项目[项目编号:2022A1515012413]。

摘　　要：目的:探讨行胃镜检查时,复合利多卡因喷喉时瑞马唑仑半数有效剂量(ED50),为安全有效用药提供一定的指导。方法:选取2024年6~8月在珠海市人民医院内镜中心接受无痛胃镜检查患者,接受检查前用喉麻管喷洒2%盐酸利多卡因,随后通过静脉注射瑞马唑仑来完成麻醉过程。瑞马唑仑的初始诱导剂量被设定为0.25 mg/kg,依据阳性反应的出现情况,增减0.02 mg/kg,以便更精确地确定下一例患者所需的诱导剂量。在静注瑞马唑仑后,心率增快降至基础水平且改良警觉/镇静评分(MOAA/S)≤1分时置入胃镜,出现吞咽和咳嗽等阳性反应时,下一例患者瑞马唑仑诱导剂量增加0.02 mg/kg。反之,下一例患者的诱导剂量减少0.02 mg/kg。当出现7次交叉后停止研究。采用Probit计算瑞马唑仑的ED50及其95%CI。结果:共31例患者完成试验。麻醉期间,平均动脉压(MAP)均有下降趋势,差异有统计学意义(P<0.05),但下降幅度未超过20%,无需处理即可自行缓解。插入胃镜时心率稍增快,差异有统计学意义(P<0.05),氧分压(SpO 2)用药后虽有所下降,但没有出现低氧血症的患者。患者苏醒时间为(11.1±2.2)min。瑞马唑仑复合利多卡因喷喉在胃镜诊疗中抑制患者阳性反应的ED50为0.240 mg/kg,95%CI为0.194~0.275 mg/kg。结论:联合利多卡因喷喉时,瑞马唑仑抑制患者胃镜阳性反应的ED50为0.240 mg/kg,呼吸循环稳定,镇静效果确切。Objective The purpose of this study was to investigate the median effective dose(ED50)of remazolam combined with lidocaine during gastroscopy,so as to provide guidance for safe and effective clinical rational application.Method Patients undergoing painless upper gastroscopy at Endoscopy Center of Zhuhai People's Hospital from June 2024 to August 2024 were enrolled.After 2%lidocaine by a throat anesthetic tube,anesthesia process was completed with intravenous injection of remazolam.The initial induction dose of remazolam was set at 0.25mg/kg,with an increase or decrease of 0.02mg/kg depending on the occurrence of a positive reaction,in order to precisely determine the required induction dose for the next patient.After intravenous remazolam,when the heart rate increased to the baseline and the modified observe assessment of alertness/sedation score(MOAA/S)was≤1,the gastroscope was inserted,and when positive reactions such as swallowing,coughing and physical movement occurred,the induced dose of remazolam was increased by 0.02 mg/kg for the next patient.Conversely,the induced dose in the next patient was reduced by 0.02 mg/kg.The study was ended when 7 crossing points appeared.The ED50 and 95%CI of remazolam were calculated by probit regression analysis.Results A total of 31 patients completed the trial.During anesthesia,MAP showed a downward trend(P<0.05),but the decrease was less than 20%,and it could be resolved without treatment.The heart rate increased slightly when the gastroscope was inserted(P<0.05),and there were no patients with hypoxemia.The recovery time of the patient was(11.1±2.2)min.The ED50 and 95%CI of remazolam combined with lidocaine in inhibiting positive reaction of patients during gastroscopy were 0.240mg/kg and 0.194~0.275mg/kg,respectively.Conclusion When combined with lidocaine,the ED50 of remazolam in reactions to insertion of endoscopy was 0.240mg/kg.Moreover,it has stable respiratory and circulatory system,and the anesthesia effect is accurate.

关 键 词：瑞马唑仑 利多卡因 胃镜检查 半数有效剂量 

分 类 号：R614[医药卫生—麻醉学]