不同剂量瑞马唑仑在肥胖患者无痛结肠镜中的麻醉效果比较  

Efficacy and safety of remimazolam at different doses in painless colonoscopy for obese patients

作　　者：徐海 朱婷婷 周红梅 XU Hai;ZHU Tingting;ZHOU Hongmei(Department of Anesthesiology,the Second Hospital of Jiaxing,Jiaxing 314000,China)

机构地区：[1]嘉兴市第二医院麻醉科,314000

出　　处：《浙江医学》2024年第23期2535-2540,共6页Zhejiang Medical Journal

基　　金：嘉兴市科技计划项目(2022AD30027)。

摘　　要：目的探讨不同剂量瑞马唑仑复合阿芬太尼在肥胖患者无痛结肠镜中的有效性和安全性。方法前瞻性选取2022年4至12月嘉兴市第二医院内镜中心择期行无痛结肠镜检查的患者179例,采用随机数字表法将患者分为P组44例、R1组45例、R2组46例和R3组44例。麻醉诱导时所有患者静脉缓慢注射盐酸阿芬太尼10μg/kg,30 s后P组、R1组、R2组及R3组患者分别静脉缓慢注射丙泊酚1.50 mg/kg、瑞马唑仑0.15 mg/kg、瑞马唑仑0.25 mg/kg及瑞马唑仑0.35 mg/kg。观察4组患者在入检查室时(T0)、进镜至乙状结肠时(T_(1))、进镜至脾曲时(T_(2))、进镜至肝区时(T_(3))、进镜至回盲部时(T_(4))以及检查结束时(T_(5))的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和脉搏血氧饱和度(SpO_(2))。记录4组患者检查时间、苏醒时间、离院时间、操作者满意度、患者满意度、镇静成功率以及低血压、心动过缓、低氧血症、呼吸抑制、注射痛、术中体动、头晕、恶心、呕吐等不良反应的发生情况。结果与P组比较,R1、R2及R3组苏醒时间、离院时间均明显较短(均P<0.05),R2组操作者满意度较高(P<0.05),R1组镇静成功率较低(P<0.05);与R1组比较,R2组镇静成功率、操作者满意度均较高(均P<0.05),R3组苏醒时间和离院时间均较长,但操作者满意度较高(均P<0.05);与R3组比较,R2组苏醒时间、离院时间均较短,操作者满意度较高(均P<0.05)。与P组比较,R1组T_(1)~T_(3)时的MAP和SpO_(2)均明显增大,T_(1)~T_(5)时的HR和RR均明显增大,R2组T_(1)~T_(3)时的MAP和SpO_(2)均明显增大,T_(1)~T_(5)时的HR和RR均明显增大,R3组T_(1)~T_(2)时的MAP均明显增大,T_(2)~T_(5)时的HR明显增大,T_(1)~T_(5)时的RR明显增大,T_(2)时的SpO_(2)明显增大,差异均有统计学意义(均P<0.05);与R3组比较,R2组T_(1)时的MAP、HR均明显增大,差异均有统计学意义(均P<0.05)。与P组比较,R1、R2、R3组低血压、低氧血症发生率均明显�Objective To compare the efficacy and safety of remimazolam at different doses with alfentanil in painless colonoscopy for obese patients.Methods A total of 179 patients undergoing elective painless colonoscopy at the Endoscopy Center of the Second Hospital of Jiaxing from April to December 2022 were enrolled in the study.The patients were randomly divided into four groups;during anesthesia induction,30 second after intravenous injection of 10μg/kg alfentanil hydrochloride,patients in groups P(n=44),R1(n=45),R2(n=46),and R3(n=44)were administered a slow intravenous injection of propofol 1.50 mg/kg,remimazolam 0.15 mg/kg,remimazolam 0.25 mg/kg,and remimazolam 0.35 mg/kg,respectively.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),and pulse oxygen saturation(SpO_(2))were measured at the time of entering the examination room(T0),during insertion of the scope up to the sigmoid colon(T_(1)),splenic flexure(T_(2)),hepatic flexure(T_(3)),cecum(T_(4)),and at the end of the examination(T_(5)).The examination duration,recovery time,discharge time,operator satisfaction,patient satisfaction,sedation success rate,and adverse events(hypotension,bradycardia,hypoxemia,respiratory depression,injection pain,intraoperative movement,dizziness,and nausea/vomiting)were compared among groups.Results Compared with group P,groups R1,R2 and R3 had significantly shorter recovery time and discharge time(all P<0.05),operator satisfaction was the highest in group R2(P<0.05),while the sedation success rate was lowerest in group R1(P<0.05).Compared with group R1,group R2 showed higher sedation success rates and operator satisfaction(both P<0.05).Group R3 had longer recovery and discharge times but higher operator satisfaction(all P<0.05).Compared with group R3,group R2 had shorter recovery and discharge times and higher operator satisfaction(all P<0.05).Compared with group P,the MAP and SpO_(2) of group R1 significantly increased at T_(1) to T_(3),and the HR and RR significantly increased at T_(1) to T_(5);in group R2,MAP a

关 键 词：阿芬太尼 苯二氮类 肥胖症 结肠镜检查 

分 类 号：R614[医药卫生—麻醉学] R574.62[医药卫生—外科学]