摘要
目的探讨肥胖患者无痛胃镜检查采用苯磺酸瑞马唑仑与阿芬太尼联合麻醉的效果和安全性。方法行无痛胃镜检查的肥胖患者148例,随机分为丙泊酚组65例和瑞马唑仑组83例。2组均采用全凭静脉麻醉,丙泊酚组静脉注射阿芬太尼7μg/kg+丙泊酚1.5 mg/kg(首次剂量),瑞马唑仑组静脉注射阿芬太尼7μg/kg+苯磺酸瑞马唑仑0.15 mg/kg(首次剂量),检查中维持改良警觉/镇静量表(modified observer’s assessment of alertness/sedation scale,MOAA/S)评分≤3分。MOAA/S评分>3分时,丙泊酚组每次追加丙泊酚0.5 mg/kg,瑞马唑仑组每次追加苯磺酸瑞马唑仑2.5 mg,至胃镜检查结束。比较2组体质量指数、检查时间、苏醒时间、出恢复室时间、阿芬太尼用量、重复给药率等临床资料;记录术中低氧血症、心血管不良事件、体动、呛咳及术后不良反应发生情况。结果瑞马唑仑组苏醒时间[7.13(4.30,8.91)min]短于丙泊酚组[7.97(5.15,10.83)min](P<0.05),重复给药率(45.78%)低于丙泊酚组(63.08%)(P<0.05),男性比率、年龄、体质量指数、检查时间、阿芬太尼用量、出恢复室时间与丙泊酚组比较差异均无统计学意义(P>0.05)。瑞马唑仑组术中低氧血症(8.4%)、低血压(62.7%)、心率减慢(9.7%)及术后腹痛腹胀(6.0%)发生率均低于丙泊酚组(20.0%、81.5%、44.6%、16.9%)(P<0.05),术中心率增快发生率(19.3%)高于丙泊酚组(3.1%)(P<0.05),术中高血压、呛咳、体动及术后恶心呕吐、头晕头痛、嗜睡乏力发生率与丙泊酚组比较差异均无统计学意义(P>0.05)。结论与丙泊酚联合阿芬太尼相比,苯磺酸瑞马唑仑联合阿芬太尼用于肥胖患者无痛胃镜检查麻醉时重复给药少,术中低氧血症、心血管不良事件及术后胃肠道反应发生率低,麻醉安全、有效。
Objective To investigate the effect and safety of remimazolam besylate combined with alfentanil in painless gastroscopy in obese patients.Methods Totally 148 obese patients undergoing painless gastroscopy were randomly divided into propofol group(n=65)and remimazolam besylate group(n=83).Both groups received total intravenous anesthesia.Propofol group was intravenously injected with 7μg/kg alfentanil and 1.5 mg/kg propofol for initial dose,while remimazolam besylate group was intravenously injected with 7μg/kg alfentanil and 1.5 mg/kg remimazolam besylate for initial dose.Modified observer’s assessment of alertness/sedation scale(MOAA/S)score was maintained 3 or less during gastroscopy.If MOAA/S score was over 3,propofol was added 0.5 mg/kg each time to propofol group and remimazolam besylate was added 2.5 mg each time to remimazolam besylate group till the end of gastroscopy.The body mass index,examination time,awakening time,time of leaving recovery room,dose of alfentanil,rate of repeating drug administration,and incidences of intraoperative hypoxemia,adverse cardiovascular events,body movement,choking and postoperative adverse reactions were compared between two groups.Results The awakening time was shorter in remimazolam besylate group[7.13(4.30,8.91)min]than that in propofol group[7.97(5.15,10.83)min](P<0.05),the rate of repeating drug administration was lower in remimazolam besylate group(45.78%)than that in propofol group(63.08%)(P<0.05),and there were no significant differences in the male ratio,age,body mass index,examination time,dose of alfentanil,and time of leaving recovery room between two groups(P>0.05).The incidences of intraoperative hypoxemia,hypotension,reduced heart rate and postoperative abdominal pain were lower in remimazolam besylate group(8.4%,62.7%,9.7%,6.0%)than those in propofol group(20.0%,81.5%,44.6%,16.9%)(P<0.05),the incidence of increased heart rate was higher in remimazolam besylate group(19.3%)than that in propofol group(3.1%)(P<0.05),and there were no significant differenc
作者
康鑫鑫
王中玉
周俊飞
徐畅
李璐
吕蕴琦
KANG Xin-xin;WANG Zhong-yu;ZHOU Jun-fei;XU Chang;LI Lu;LYU Yun-qi(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)
出处
《中华实用诊断与治疗杂志》
2022年第7期744-746,共3页
Journal of Chinese Practical Diagnosis and Therapy
基金
白求恩·围术期镇痛镇静研究项目(BCF-RF-WSQZTZJ-202011-010)。
