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Received:October 29, 2022 Published Online:August 20, 2023
Received:October 29, 2022 Published Online:August 20, 2023
中文摘要: 目的观察小剂量瑞马唑仑复合丙泊酚在老年患者无痛胃肠镜诊疗中的安全性和有效性。方法选择2022年2月至7月在河北省人民医院行无痛胃肠镜诊疗的老年患者120例。采用随机数字表法将患者分为C组(丙泊酚1.5mg/kg)、R1组(瑞马唑仑0.05mg/kg复合丙泊酚1mg/kg)和R2组(瑞马唑仑0.1mg/kg复合丙泊酚1mg/kg),每组各40例。记录患者入室后(T1)、麻醉诱导后MOAA/S评分为0分时(T2)、置入胃镜时(T3)、检查结束时(T4)的SBP、DBP、HR、SpO2和脑电双频指数(BIS)值。记录镇静成功率、丙泊酚用量、内镜检查时间、苏醒时间、离开麻醉恢复室时间、患者满意度及操作医师满意度等。观察并记录患者术中和术后不良反应。结果与T1比较,T2、T3、T4时三组HR、SBP、DBP、BIS明显降低(P<0.05)。T2时R1组和R2组SBP、DBP、BIS下降幅度较C组减小(P<0.05);三组丙泊酚用量、苏醒时间、离室时间(F=164.904、29.878、89.058,P<0.05)及低氧血症、低血压、呃逆、体动反应和注射痛发生率(χ2=8.772、11.563、9.697、8.607、21.943,P<0.05)差异有统计学意义。与C组比较,R1、R2组丙泊酚的总用量减少(P<0.05),苏醒时间和离开恢复室时间缩短(P<0.05),呃逆发生率升高(P<0.05),低氧血症体动反应、低血压、注射痛发生率均降低(P<0.05)。结论瑞马唑仑复合丙泊酚麻醉方案,可以维持血流动力学稳定,减少丙泊酚用量,缩短苏醒时间和离室时间,降低不良反应发生率,可以安全、有效的应用于老年患者无痛胃肠镜检查中。瑞马唑仑0.05mg/kg较0.1mg/kg呃逆发生率更低,对操作医师的影响更小,方案更优。
Abstract:ObjectiveTo observe the safety and effectiveness of low-dose remidazolam combined with propofol in painless gastroenterscopy in elderly patients. MethodsA total of 120 elderly patients who underwent painless gastroenteroscopy in Hebei General Hospital from February 2022 to July 2022 were selected. Patients were randomly divided into group C(1.5mg/kg propofol), group R1(0.05mg/kg remidazolam combined with 1mg/kg propofol) and group R2(0.1mg/kg remidazolam combined with 1mg/kg propofol), 40 patients in each group. The values of SBP, DBP, HR, SpO2 and bispectral index(BIS) were recorded at four time points: after the patient entering the room(T1), the MOAA/S score being 0 after anesthesia induction(T2), the gastroscope being inserted(T3) and the end of examination(T4). The success rate of sedation, dosage of propofol, the time of endoscopy examation, awakening time, and time of leaving the recovery room, the satisfaction of patients and operating physician were recorded. The adverse reactions during and after operation were observed and recorded. ResultsCompared with T1, HR, SBP, DBP and BIS values of three groups were significantly decreased at T2, T3 and T4(P<0.05). At T2, the values of SBP, DBP and BIS in group R1 and group R2 were significantly higher than those in group C(P<0.05). There were statistically significant differences in the dosage of propofol, the time of awakening, the time of leaving the room (F=164.904, 29.878, 89.058, P<0.05) and the incidence of hypoxemia, Hypotension, hiccup, body motion reaction and injection pain (χ2=8.772, 11.563, 9.697, 8.607, 21.943, P<0.05) among the three groups. Compared with group C, in R1 and R2 group the total dosage of propofol reduced significantly(P<0.05), the time for awakening and leaving recovery room shortened(P<0.05), the incidence of hiccups increased(P<0.05), while the incidences of hypoxemia, body movement reaction, hypotension and injection pain reduced significantly(P<0.05). ConclusionA combined propofol anesthetic regimen with remazolam, which can stably maintain hemodynamic changes, reduce the amount of propofol, shorten the time of awakening and leauing recovery room, and reduce the incidence of adverse effects. It can be safely and effectively applied to elderly patients during painless gastrointestinal endoscopy. Rimazoparin 0.05 mg/kg is associated with a lower incidence of hiccups than 0.1 mg/kg, has less impact on the operating physician, and the protocol is more optimal.
keywords: Remazolam Propofol Elderly Painless gastroenteroscopy Anesthesia depth monitoring Bispectral index Wake time Hiccup
文章编号: 中图分类号:R614.2+4 文献标志码:B
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