瑞马唑仑对老年衰弱患者无痛胃镜检查术的镇静效果

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摘要目的探索瑞马唑仑对老年衰弱患者无痛胃镜检查术的镇静效果。方法选择2023年5-7月于山西医科大学第二医院门诊内镜中心拟行择期无痛胃镜检查的老年衰弱患者360例,年龄65～80岁,ASA分级Ⅱ或Ⅲ级,BMI 18～30 kg/m²,临床衰弱量表(CFS)评分≥5分,记录术前开放静脉通路时(T₀)及术中胃镜通过咽喉部时(T₁)抽血检测血清中去甲肾上腺素(NA)、皮质醇(Cor)、Apelin-13。采用随机数字表法分为四组(n=90):R1组、R2组和R3组瑞马唑仑分别为0.1、0.2、0.3 mg/kg,P组为丙泊酚1.5 mg/kg。待患者 MOAA/S评分≤3分及睫毛反射消失后手术开始。记录首次镇静成功率、胃镜检查时间、检查结束后苏醒时间及PACU停留时间,记录外周血指标变化情况及不良反应发生率,随访内镜医师及患者满意度。结果与P组相比,R1组首次镇静成功率(63.3% vs. 96.7%)显著降低,检查时间[(7.23±1.81)min vs. (5.78±1.83)min]显著延长,T₁时外周血中NA、Cor[(4.72±0.56) ng/ml vs. (3.98±0.52) ng/ml],[(143.75±10.47) nmol/L vs. (126.61±9.54) nmol/L]显著升高, Apelin-13[(2.16±0.49) ng/ml vs. (2.81±0.58) ng/ml]显著降低,呛咳、体动发生率(40.0% vs. 17.7%,31.1% vs. 13.3%)显著增高(P<0.05);R2组患者术中检查平稳,低血压,低血氧饱和度发生率明显降低(P＜0.05);R3组患者苏醒时间[(12.82±2.33)min]及PACU停留时间[(32.5±5.5)min]明显延长(P＜0.05)。与R1组相比,R2组首次镇静成功率 (94.4%)明显升高,苏醒时间[(6.59±2.02) min]及PACU停留时间[(23.8±5.1)min]明显缩短,呛咳和体动发生率(14.4%,8.9%)显著降低( P＜0.05)。与R2组比较,R3组苏醒时间及PACU停留时间显著延长(P＜0.05)。结论瑞马唑仑镇静效果好,恢复质量优,可安全有效应用于老年衰弱患者胃镜检查,且0.2 mg/kg剂量能够使老年衰弱患者检查过程更加平稳,不良反应减少。

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关键词 ：瑞马唑仑, 丙泊酚, 衰弱, 无痛胃镜

Abstract：Objective To explore the sedative effect of remazolam on frail elderly patients undergoing painless gastroscopy. Methods A total of 360 frail elderly patients aged 65-80 years old and with the ASA classification of Ⅱ or Ⅲ, the BMI of 18 to 30 kg/m², and CFS score ≥ 5 were selected to undergo elective painless gastroscopy in the outpatient endoscopy center of the Second Hospital of Shanxi Medical University from May to July 2023. Serum Norepinephrine(NA), cortisol (Cor), and Apelin-13 were measured by blood samples during preoperative opening of venous access (T₀) and intraoperative gastroscopy through throat (T₁), respectively. The patients were divided into four groups (n=90) using a randomized numerical table: 0.1, 0.2, 0.3 mg/kg of remazolam in groups R1, R2, and R3, respectively, and 1.5 mg/kg of propofol in group P. Surgery was initiated when the patients' MOAA/S scores were ≤3 and the eyelash reflex disappeared. The success rate of the first sedation, the time of gastroscopy, the time of awakening after the examination and the duration of stay in PACU and the changes of peripheral blood indexes and the incidence of adverse reactions were recorded, and the satisfaction of endoscopists and patients were followed up. Results Compared with P group, the success rate of first sedation (63.3% vs. 96.7%) was significantly lower and the examination time [(7.23±1.81) min vs. (5.78±1.83) min] was significantly longer in R1 group. In addition, NA [(4.72±0.56)ng/ml vs. (3.98±0.52) ng/ml] and Cor [(143.75±10.47) nmol/L vs. (126.61±9.54) nmol/L] in peripheral blood at T₁ were significantly elevated, and the incidence of choking and somatic movement (40.0% vs. 17.7%, 31.1% vs. 13.3%) were significantly higher (P<0.05); whereas, the peripheral blood of Apelin-13 [(2.16±0.49) ng/ml vs. (2.81±0.58) ng/ml] was significantly lower. Intraoperative examination of patients in R2 group was smooth, the incidence of hypotension and low oxygen saturation was significantly lower (P<0.05); In group R3, the awakening time [(12.82±2.33)min] and PACU stay time [(32.5±5.5)min] were significantly longer (P<0.05). Compared with group R1, group R2 had a significantly higher rate of successful first sedation (94.4%), a significantly shorter awakening time [(6.59±2.02) min] and PACU stay [(23.8±5.1) min], and a significantly lower incidence of choking and movement (14.4%, 8.9%) (P<0.05).Compared with R2 group, the awakening time and PACU stay in the R3 group was statistically prolonged (P<0.05). Conclusions Remazolam has good sedative effect and excellent recovery quality, and can be safely and effectively used in gastroscopy in elderly frail patients. The remazolam dose of 0.2 mg/kg can make the examination process of elderly frail patients smoother and reduce the adverse reactions.

Key words： remazolam propofol frail painless gastroscopy

收稿日期: 2023-07-28

ZTFLH:

R614

基金资助:山西省医师协会医师临床科研项目(YSXH-RF2022MZ004)

作者简介: 秦文艳,硕士,副主任医师。

引用本文:

秦文艳, 范俊柏, 殷昊, 高彤彤. 瑞马唑仑对老年衰弱患者无痛胃镜检查术的镇静效果[J]. 武警医学, 2023, 34(12): 1025-1029. QIN Wenyan, FAN Junbai, YIN Hao, GAO Tongtong. Sedative effect of remazolam on frail elderly patients undergoing painless gastroscopy. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(12): 1025-1029.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2023/V34/I12/1025

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