瑞马唑仑复合舒芬太尼用于肝硬化食管胃静脉曲张老年患者内镜下硬化剂注射术麻醉效果的评价
Evaluation of anesthetic effect of remazolam when combined with sufentanil in elderly patients with liver cirrhosis and esophageal and gastric varices undergoing endoscopic sclerotherapy
黄栋 1马亮 2江泽宇 1沈江 1徐青荣1
作者信息
- 1. 苏州大学附属第三医院麻醉科,常州 215006
- 2. 苏州大学附属第三医院消化科,常州 215006
- 折叠
摘要
目的 评价瑞马唑仑复合舒芬太尼用于肝硬化食管胃静脉曲张老年患者内镜下硬化剂注射术的麻醉效果.方法 选取本院2022年3月至2023年9月行非气管插管全麻内镜下硬化剂注射术的肝硬化食管胃静脉曲张老年患者150例,性别不限,年龄65～80岁,BMI 18～24 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=75):舒芬太尼复合丙泊酚组(PS组)和舒芬太尼复合瑞马唑仑组(RS组).PS组静脉注射丙泊酚1～2mg/kg及舒芬太尼0.1 μg/kg麻醉诱导,静脉泵注丙泊酚4～10 mg·kg-1·h-1麻醉维持;RS组静脉注射瑞马唑仑0.1～0.2 mg/kg及舒芬太尼0.1 μg/kg麻醉诱导,静脉泵注瑞马唑仑0.5～2 mg·kg-1·h-1麻醉维持.2组术中BIS值维持40～60.待患者意识消失(改良警觉/镇静评分≤1分)时置入内镜.2组患者均于食管黏膜下曲张静脉注射硬化剂聚桂醇注射液.记录意识消失时间和意识恢复时间、术中体动和心血管事件发生情况、术后低氧血症及呕心呕吐发生情况,采用视觉模拟评分法评价术者-患者满意度.结果 与PS组比较,RS组术中心动过缓发生率、意识消失时间和意识恢复时间差异无统计学意义(P＞0.05),术中低血压发生率降低,术后低氧血症及恶心呕吐发生率降低,术者及患者满意度评分升高(P＜0.05).2组患者术中均未见明显体动反应发生.结论 舒芬太尼复合瑞马唑仑用于肝硬化食管胃静脉曲线老年患者内镜下硬化剂注射术的麻醉效果优于舒芬太尼复合丙泊酚.
Abstract
Objective To evaluate the anesthetic effect of remazolam when combined with sufen-tanil in elderly patients with liver cirrhosis and esophageal and gastric varices undergoing endoscopic sclero-therapy.Methods A total of 150 cirrhotic patients with liver cirrhosis and esophageal and gastric varices,regardless of gender,aged 65-80 yr,with body mass index of 18-24 kg/m2,of American Society of Anes-thesiologists Physical Status classification Ⅱ or Ⅲ,who underwent endoscopic sclerotherapy under non-intu-bated general anesthesia from March 2022 to September 2023 in our hospital,were selected and divided into 2 groups(n=75 each)by a random number table method:sufentanil plus propofol group(PS group)and sufentanil plus remazolam group(RS group).Anesthesia was induced with intravenous propofol 1-2 mg/kg and sufentanil 0.1 μg/kg and maintained by intravenous infusion of propofol 4-10 mg·kg-1·h-1 in PS group.Anesthesia was induced with intravenous remimazolam 0.1-0.2 mg/kg and sufentanil 0.1 μg/kg and was maintained with intravenous infusion of remimazolam 0.5-2.0 mg·kg-1·h-1 in RS group.BIS values were maintained between 40 and 60 during operation in both groups.Endoscopy was placed when the pa-tients lost consciousness(modified observer's assessment of alertness/sedation score ≤1).Sclerosing agent laurosinol injection was injected into esophageal submucosal varices in both groups.The time to loss of con-sciousness and recovery of consciousness,intraoperative body movement and cardiovascular events,and postoperative hypoxemia and nausea and vomiting were recorded.The operator-patient satisfaction was as-sessed by the visual analogue scale.Results Compared with PS group,no significant changes were found in the incidence of intraoperative bradycardia,time to loss of consciousness and time to recovery of consciousness(P＞0.05),the incidence of intraoperative hypotension was significantly decreased,the incidence of postoper-ative hypoxemia and nausea and vomiting was decreased,and the satisfaction scores for operators and patients were increased in RS group(P＜0.05).No obvious body movement was found in the two groups.Conclusions Sufentanil combined with remifentanil provides better anesthetic effect than sufentanil combined with propo-fol in elderly patients with esophageal and gastric varices undergoing endoscopic sclerotherapy.
关键词
苯二氮䓬类/舒芬太尼/老年人/肝硬化/食管和胃静脉曲张/硬化溶液Key words
Benzodiazepines/Sufentanil/Aged/Liver cirrhosis/Esophageal and gastric varices/Sclerosing solutions引用本文复制引用
基金项目
常州市卫生健康青苗人才项目(CZQM2022004)
常州市卫生健康委青年人才科技项目(QN202113)
常州市应用基础研究指导性项目(CJ20239011)
南京医科大学常州医学中心基础研究项目(CMCB202301)
出版年
2024
NETL
NSTL
万方数据