瑞马唑仑联合瑞芬太尼在无痛纤维支气管镜检查中的应用  

Application of Remimazolam Combined with Remifentanil in Painless Fiberoptic Bronchoscopy

作　　者：陈茵茵 孙广明 CHEN Yinyin;SUN Guangming(Puyang People's Hospital,Puyang Henan 457000,China.)

机构地区：[1]濮阳市人民医院,河南濮阳457000

出　　处：《药品评价》2024年第11期1366-1369,共4页Drug Evaluation

摘　　要：目的 探究瑞马唑仑联合瑞芬太尼在无痛纤维支气管镜检查中的应用。方法 选取于濮阳市人民医院拟行无痛纤维支气管镜检查术的肺结核患者84例,采用随机数表法分为三组,丙泊酚联合瑞芬太尼组(PR组)、低剂量瑞马唑仑联合瑞芬太尼组(RR1组)、高剂量瑞马唑仑联合瑞芬太尼组(RR2组),每组各28例。所有患者静脉输注瑞芬太尼0.35μg·kg^(-1)·min^(-1),PR组静脉注射1.5 mg/kg丙泊酚,RR1组、RR2组分别注射0.3 mg/kg、0.4 mg/kg瑞马唑仑;维持期间PR组静脉输注丙泊酚4~6 mg·kg^(-1)·h^(-1),RR1组、RR2组静脉输注瑞马唑仑0.5~1.0 mg·kg^(-1)·h^(-1)。记录诱导前(T0)、手术开始时(T1)、手术开始10 min(T2)、手术结束时(T3)、患者清醒时(T4)的血流动力学指标;记录患者麻醉镇静效果、术中及术后不良反应发生情况。结果 T1、T2、T3时,PR组、RR1组和RR2组的收缩压(SBP)、舒张压(DBP)比较差异无统计学意义(P<0.05)。PR组改良警觉/镇静(MOAA/S)评分明显低于RR1组和RR2组(P<0.05)。三组麻醉至检查时间、自主呼吸恢复时间、麻醉后监测治疗室停留时间、T1与T2时呛咳评分和体动评分比较差异无统计学意义(P>0.05)。PR组心动过缓、低血压发生率均高于RR1组和RR2组(P<0.05);RR2组呃逆发生率高于PR组、RR1组(P<0.05);PR组、RR2组呛咳发生率高于RR1组(P<0.05)。结论 在无痛纤维支气管镜检查中应用瑞马唑仑联合瑞芬太尼有利于提高肺结核患者的苏醒质量,其中0.3 mg/kg瑞马唑仑不仅可减轻对患者血流动力学的影响,还能降低不良反应发生率,是为较理想的剂量。Objective To explore the application of remimazolam combined with remifentanil in painless fiberoptic bronchoscopy.Methods A total of 84 patients with pulmonary tuberculosis who were scheduled to undergo painless fiberoptic bronchoscopy in Puyang People's Hospital were randomly divided into three groups:propofol plus remifentanil(PR group),low-dose remimazolam plus remifentanil(RR1 group),and high-dose remimazolam plus remifentanil(RR2 group),with 28 patients in each group.All patients received intravenous infusion of remifentanil 0.35μg·kg^(-1)·min^(-1),propofol 1.5 mg/kg was injected intravenously in PR group,and remidazolam 0.3 mg/kg and 0.4 mg/kg were injected intravenously in RR1 and RR2 groups,respectively.During the maintenance period,propofol 4~6 mg·kg^(-1)·h-1 was infused intravenously in PR group,and remimazolam 0.5~1.0 mg·kg^(-1)·h-1 was infused intravenously in RR1 and RR2 groups.The hemodynamic indexes before induction(T0),at the beginning of surgery(T1),10 min at the beginning of surgery(T2),at the end of surgery(T3),and when the patient is awake(T4)were recorded.The effects of anesthesia and sedation,and the occurrence of adverse reactions during and after the operation were recorded.Results At T1,T2 and T3,there were no statistically significant differences in systolic blood pressure(SBP)and diastolic blood pressure(DBP)between PR group,RR1 group and RR2 group(P<0.05).The improved vigilance/sedation(MOAA/S)score in PR group was significantly lower than that in RR1 and RR2 groups(P<0.05).The time from anesthesia to examination,the recovery time of spontaneous breathing,the stay time of PACU,the cough score and the body movement score at T1 and T2 were no statistically significant differences among the three groups(P>0.05).The incidence of bradycardia and hypotension in PR group was higher than that in RR1 and RR2 groups(P<0.05);the incidence of hiccup in RR2 group was higher than that in PR group and RR1 group(P<0.05);the incidence of cough in PR group and RR2 group was higher than that in R

关 键 词：肺结核 纤维支气管镜检查术 麻醉 瑞马唑仑 瑞芬太尼 

分 类 号：R61[医药卫生—外科学]