本文已被：浏览 67次 下载 101次
投稿时间：2023-07-19 网络发布日期：2024-04-20
投稿时间：2023-07-19 网络发布日期：2024-04-20
中文摘要: 目的 评价在肥胖患者无痛胃镜中应用艾司氯胺酮复合瑞马唑仑的效果和安全性。
方法 选择2022年1月至12月南京医科大学第四附属医院和南京市第一医院择期行无痛胃镜的患者138例，采用随机数字表法随机分为两组：艾司氯胺酮+瑞马唑仑组（S组， n=69）和丙泊酚+瑞芬太尼组（C组， n=69）。比较两组患者术中低氧血症发生率,麻醉诱导时间、检查时间、麻醉后监护室（PACU）监护时间以及医师满意度。记录两组患者麻醉前（T0）、〖JP2〗进镜时（T1）以及退镜时（T2）的平均动脉压（MAP）、心率（HR）并记录不良事件发生情况。
结果 S组患者低氧血症发生率明显低于C组［34.78%（24/69） vs 56.52%（39/69），〖JP〗 χ2=6.571， P=0.010］，麻醉诱导时间短于C组［（23.17±2.57） s vs （24.71±2.12） s， t=3.840，P＜0.01］。与C组相比，S组患者的PACU监护时间较短 ［ （14.74±1.46） s vs （17.06±1.87） s，t=8.123， P＜0.01］、消化内科医生满意度［89.86%（62/69） vs 75.36%（52/69）, χ2=5.044， P=0.025］与麻醉医生满意度［92.75%（64/69） vs 71.01%（49/69）， χ2=10.991， P=0.001］较高。T1时C组MAP显著低于S组、HR显著高于S组（P＜0.05）。C组有9例患者出现恶心呕吐、S组有5例患者出现恶心呕吐，无其他不良事件发生。
结论 与丙泊酚复合瑞芬太尼相比，瑞马唑仑复合艾司氯胺酮应用于肥胖患者无痛胃镜检查时，低氧血症发生率降低，安全性较高。
中文关键词:
Abstract:Objective To evaluate the effects and safety of esketamine combined with remimazolam in painless gastroscopy in obese patients.
Methods A total of 138 obese patients who received elective painless gastroscopy at the Fourth Affiliated Hospital of Nanjing Medical University and Nanjing First Hospital from January to December 2022 were selected and randomly divided into group S (esketamine+remimazolam, n=69) and group C (propofol+remifentanil, n=69) by random number table method. The incidence of intraoperative hypoxemia, anesthesia induction time, test time, post-anesthesia care unit (PACU) monitoring time, and physician satisfaction were compared between two groups. The mean arterial pressure (MAP) and heart rate (HR) of two groups of patients before anesthesia (T0), at endoscopy insertion (T1), and at endoscopy retraction (T2) were recorded, and the incidence of adverse events were recorded.
Results The incidence of hypoxemia in group S was significantly lower than that in group C 〖JP+1〗［34.78%(24/69) vs 56.52%(39/69)， χ2=6.571， P=0.010］. The induction time for anesthesia in group S was shorter than that in group C［(23.17±2.57) s vs (24.71±2.12) s， t=3.840， P＜0.01］. Compared with group C, the PACU monitoring time of group S was significantly shorter［(14.74±1.46) s vs (17.06±1.87) s, t=8.123， P＜0.01］,〖JP+2〗 and the satisfaction of〖JP〗 〖LM〗gastroenterologists［89.86%〖JP〗(62/69) vs 75.36%(52/69), χ2=5.044， P=0.025］ and satisfaction of anesthesiologists［92.75%(64/69) vs 71.01%(49/69), χ2=10.991， P=0.001］ was significantly higher. At T1, MAP in Group C decreased compared to group S, while HR increased compared to group S (P＜0.05). Nausea and vomiting occurred in 9 patients in group C and 5 patients in group S, and no other adverse event occurred.
Conclusion Compared with propofol combined with remifentanil, remimazolam combined with eszketamine for painless gastroscopy in obese patients can reduce the incidence of hypoxemia and has higher safety.
keywords: Painless gastroscopy Obesity Remimazolam Esketamine Propofol Remifentanil Mean arterial pressure Nausea Vomiting
文章编号： 中图分类号：R614.2 文献标志码：A
基金项目:
| 作者 | 单位 |
| 翁立阳1 | 1. 南京医科大学第四附属医院麻醉科，江苏 南京 211800； |
| 杨玉春1 | 1. 南京医科大学第四附属医院麻醉科，江苏 南京 211800； |
| 毛菇 1 | 1. 南京医科大学第四附属医院麻醉科，江苏 南京 211800； |
| 张勇2 | 2. 南京医科大学附属南京医院 南京市第一医院麻醉科，江苏 南京 210006； |
| 谢力1 | 1. 南京医科大学第四附属医院麻醉科，江苏 南京 211800 |
| Author Name | Affiliation |
| WENG Liyang*, YANG Yuchun, MAO Gu, ZHANG Yong, XIE Li | *Department of Anesthesiology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 211800, China |
引用文本：
翁立阳,杨玉春,毛菇 ,等.艾司氯胺酮复合瑞马唑仑在肥胖患者无痛胃镜中的应用[J].中国临床研究,2024,37(4):540-543.
翁立阳,杨玉春,毛菇 ,等.艾司氯胺酮复合瑞马唑仑在肥胖患者无痛胃镜中的应用[J].中国临床研究,2024,37(4):540-543.