吸烟因素对胃镜检查术患者复合阿芬太尼时瑞马唑仑镇静效力的影响  

Effect of smoking on sedative potency of remimazolam combined with alfentanil in patients undergoing painless gastroscopy

作　　者：黄瑾 张珈硕 李世昌 韩亚楠 王晟昱 刘岩 贾宏泽 吴慧 勾先兵 王春光[1] Huang Jin;Zhang Jiashuo;Li Shichang;Han Yanan;Wang Shengyu;Liu Yan;Jia Hongze;Wu Hui;Gou Xianbing;Wang Chunguang(Department of Anesthesiology,Baoding First Central Hospital,Baoding 071000,China;Graduate School of Chengde Medical University,Chengde 067000,China;First Department of Endoscopy,Baoding First Central Hospital,Baoding 071000,China;Operating Room,Baoding First Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院麻醉科,保定071000 [2]承德医学院研究生学院,承德067000 [3]保定市第一中心医院内镜一科,保定071000 [4]保定市第一中心医院手术室,保定071000

出　　处：《中华麻醉学杂志》2025年第1期77-81,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价吸烟因素对胃镜检查术患者复合阿芬太尼时瑞马唑仑镇静效力的影响。方法本试验为前瞻性、单中心研究。选取保定市第一中心医院2023年10月至12月择期行胃镜检查术男性患者,年龄30~75岁,BMI 18~28 kg/m^(2),ASA分级Ⅰ或Ⅱ级,根据患者吸烟情况,分为非吸烟组、轻度吸烟组(吸烟指数≤200)、中度吸烟组(200<吸烟指数<400)和重度吸烟组(吸烟指数≥400)。静脉注射阿芬太尼5μg/kg和瑞马唑仑,待患者睫毛反射消失、下颌松弛、改良警觉/镇静(MOAA/S)评分≤1分后进行胃镜检查。采用Dixon序贯法确定瑞马唑仑镇静的半数有效剂量(ED 50)。瑞马唑仑初始剂量设定为0.2 mg/kg,剂量梯度为0.02 mg/kg,阳性反应定义:静脉注射瑞马唑仑3 min后MOAA/S评分>1分,或进镜时出现呛咳、吞咽、体动等影响操作的反应。结果本研究共纳入85例患者,非吸烟组21例,轻度吸烟组21例,中度吸烟组20例,重度吸烟组23例。吸烟组瑞马唑仑ED 50高于非吸烟组(P<0.05),轻度吸烟组、中度吸烟组、重度吸烟组瑞马唑仑ED 50逐渐升高(P<0.05)。结论吸烟因素可降低复合使用阿芬太尼时瑞马唑仑对胃镜检查术患者的镇静效力。ObjectiveTo evaluate the effect of smoking on the sedative potency of remimazolam combined with alfentanil in patients undergoing painless gastroscopy.MethodsThis was a prospecctive single-center study.American Society of Anesthesiologists Physical Status classificationⅠorⅡmale patients,aged 30-75 yr,with a body mass index of 18-28 kg/m^(2),undergoing elective painless gastroscopy at Baoding First Central Hospital from October to December 2023,were divided into non-smoking group,mild smoking group(smoking index≤200),moderate smoking group(200<smoking index<400)and heavy smoking group(smoking index≥400)based on the status of smoking.Alfentanyl 5μg/kg and remimazolam were intravenously injected.Gastroscopy was performed after the patient′s eyelash reflex disappeared,the jaw was relaxed,and the Modified Observer′s Assessment of Alertness/Sedation scale score≤1.The median effective dose(ED 50)of remimazolam was determined by the Dixon′s up-and-down method.The initial dose of remimazolam was 0.2 mg/kg with a increment/decrement of 0.02 mg/kg.A positive response was defined as the Modified Observer′s Assessment of Alertness/Sedation scale score>1 after 3 min of remimazolam injection or development of bucking,swallowing,body movement and other responses that affected operations during insertion of the endoscope.ResultsA total of 85 patients were finally included,with 21 in non-smoking group,21 in mild smoking group,20 in moderate smoking group and 23 in heavy smoking group.The ED 50 of remimazolam was significantly higher in smoking groups than in non-smoking group(P<0.05).The ED 50 of remimazolam gradually increased in mild,moderate and heavy smoking groups(P<0.05).ConclusionsSmoking can decrease the sedative potency of remimazolam when combined with alfentanil in patients undergoing painless gastroscopy.

关 键 词：吸烟 苯二氮[艹卓]类 阿芬太尼 胃镜检查 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]