摘要
目的 观察瑞马唑仑与丙泊酚不同给药顺序在无痛胃镜检查中对患者呼吸、循环及不良反应等的影响.方法 选择2023年3月-2023年6月在武汉大学人民医院行无痛胃镜检查患者,按照随机数字表法1∶1随机分为瑞马唑仑-丙泊酚组(RP组)、丙泊酚-瑞马唑仑组(PR组).所有患者在给予舒芬太尼0.1 ug·kg-1后,RP组患者预给瑞马唑仑0.15 mg·kg-1随后以40 mg·kg-1·h-1泵注丙泊酚;PR组患者预给丙泊酚0.5 mg·kg-1随后以3 mg·kg-1·h-1泵注瑞马唑仑,待两组患者脑电意识深度监测Narcotrend(NT)值＜60且警觉/镇静观察(OAA/S)评分为0时停止给药并行胃镜检查.分别记录患者麻醉前(T0)、预给药后1 min(T1)、麻醉完善后1 min(T2)、麻醉完善后3 min(T3)、苏醒(T4)时的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)及脉搏氧饱和度(SpO2),同时记录两组患者瑞马唑仑用量、丙泊酚用量、麻醉时间、苏醒时间、离院时间、检查中患者体动例数、辅助呼吸例数,以及围检查期不良反应发生情况等.组间比较采用成组t检验,两组患者围检查期间生命体征的变化采用重复测量方差分析.结果 与T0时相比,两组患者在T2、T3时NT值明显降低(P＜0.05),但MAP、HR、RR、SpO2与T0相比差异均无统计学意义(P＞0.05).两组患者之间MAP、HR、RR、SpO2及NT值在不同时刻差异均无统计学意义(P＞0.05).两组患者麻醉期间瑞马唑仑及丙泊酚用量、麻醉时间、苏醒时间、离院时间、检查中体动、检查中辅助呼吸等麻醉效果指标,以及围检查期间两组患者心动过缓、低血压、呼吸抑制、低氧血症、恶心、呕吐、眩晕乏力等不良反应指标上差异均无统计学意义(P＞0.05),但RP组患者丙泊酚注射痛显著少于PR组(P＜0.05).结论 瑞马唑仑与丙泊酚两种不同给药顺序均能获得良好的麻醉效果,且对呼吸循环无明显抑制,因此麻醉方案应基于麻醉医生的偏好、对患者安全风险因素的评估以及资源的可利用度进行个体化选择.
Abstract
Objective To compare the effects of different administration sequences of propofol and remimazolam on patients respiration,circulation,and adverse reactions during painless gastroscopy.Methods Patients who underwent painless gastroscopy at Renmin Hospital of Wuhan University from March to June 2023 were 1∶1 randomly divided into two groups using random number table method:the Remimazolam-Propofol group(RP group)and the Propofol-Remimazolam group(PR group).After both groups of patients were administered sufentanil 0.1 ug·kg-1,patients in RP group were pre-administered remimazolam 0.15 mg·kg-1,and then followed by pump injection of propofol at an injection rate of 40 mg·kg1·h1;patients in PR group were pre-administered propofol 0.5 mg·kg-1,and then followed by pump injection of remimazolam at an injection rate of 3mg·kg1·h-1.When narcotrend(NT)value＜60 and observer's assessment of alertness/sedation(OAA/S)score was 0 in both groups,gastroscopy was started.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO2)were recorded before anesthesia(T0),1 min after pre-administration(Tl),1 min after completion of anesthesia(T2),3 min after completion of anesthesia(T3),and at the time of awakening(T4).At the same time,the anesthesia effect indicators were recorded including the dosage of remimazolam or propofol during anesthesia,anesthesia time,awakening time,discharge time,peri-examination body movement cases,assisted breathing cases and adverse reactions.A paired t-test was used to compare the two groups,and repeated measurement analysis of variance was used for the changes of vital signs in the two groups during the peri-examination period.Results Compared with T0,the NT values of the two groups were significantly decreased at T2 and T3 after anesthesia(P＜0.05),but the MAP,HR,RR and SpO2 of the two groups had no significant difference compared with T0(P＞0.05).Between the two groups at each time point,there was no statistically significant difference in MAP,HR,RR,SpO2 and NT values(P＞0.05).There was no significant difference between the two groups in anesthesia effect indicators such as the dosage of remimazolam and propofol,anesthesia time,awakening time,leaving hospital time,body movement cases,assisted breathing cases,and peri-examination adverse reaction indicators,such as bradycardia,hypotension,respiratory depression,hypoxemia,nausea,vomiting,dizziness and fatigue(P＞0.05),but the propofol injection pain in RP group was significantly less than that in PR group(P＜0.05).Conclusion Pre-injection of low-dose remimazolam or propofol,followed by appropriate dosage of propofol or remimazolam could obtain good anesthetic effect without obvious inhibition of respiratory and circulatory according to different administration orders.Therefore,the choice of sedation should be individualized based on the anesthesiologist's preferences,the assessment of patients'risk factors and the availability of resources.
基金项目
湖北省自然科学基金面上项目(2020CFB705)
维普
万方数据