瑞马唑仑用于门诊无痛胃镜镇静的临床观察

来源:用户上传      作者:张毅 叶刚 张亮 李思彤 向俊 牟俊英 姚娜娜 朱贤林

　　中D分类号 R614.2+4;R971+.2 文献标志码 A 文章编号 1001-0408（2022）04-0492-05
　　DOI 10.6039/j.issn.1001-0408.2022.04.18
　　摘 要 目的 观察瑞马唑仑用于无痛胃镜镇静的有效性和安全性。方法 选择2021年3-6月于恩施土家族苗族自治州中心医院门诊择期行无痛胃镜检查的患者84例，采用随机数字表法联合信封分配隐藏法将其分为观察组和对照组，每组42例。观察组患者缓慢静脉注射枸橼酸舒芬太尼注射液0.1 μg/kg+注射用甲苯磺酸瑞马唑仑0.2 mg/kg，对照组患者缓慢静脉注射枸橼酸舒芬太尼注射液0.1 μg/kg+丙泊酚乳状注射液2 mg/kg，待患者意识消失后进行胃镜检查。观察两组患者的镇静有效率、镇静起效时间、苏醒时间和不良反应发生情况，记录两组患者入室后（T0）、麻醉诱导完成后（T1）、胃镜进入咽喉时（T2）、退镜结束时（T3）、胃镜检查结束后5 min时（T4）的心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）和改良警觉/镇静评分（MOAA/S）评分、Narcotrend评分。结果 两组患者的镇静有效率（均为100%）和呼吸抑制、恶心呕吐发生率比较，差异均无统计学意义（P>0.05）。观察组患者的镇静起效时间显著长于对照组，苏醒时间和低血压、需治疗的低血压、注射痛、心动过缓发生率均显著短于或低于对照组（P<0.05）。T0时，两组患者的HR、MAP、SpO2、MOAA/S评分、Narcotrend评分比较，差异均无统计学意义（P>0.05）。T1～T4时，对照组患者的HR均显著低于同组T0时，且显著低于同期观察组（P<0.05）;T1～T3时，两组患者的MAP均显著低于同组T0时（P<0.05），但两组间比较及T4与T0时比较差异均无统计学意义（P>0.05）。两组患者不同时间点的SpO2、观察组患者不同时间点的HR比较差异均无统计学意义（P>0.05）。T1～T3时，两组患者的MOAA/S评分、Narcotrend评分均显著低于同组T0时，而观察组患者T1、T3时的MOAA/S评分和T3时的Narcotrend评分均显著高于同期对照组，其T2时的Narcotrend评分显著低于同期对照组（P<0.05）;T4时，两组患者的MOAA/S评分、Narcotrend评分比较差异均无统计学意义（P>0.05）。结论 瑞马唑仑用于无痛胃镜的镇静效果与安全性均较好。
　　关键词 无痛胃镜;瑞马唑仑;丙泊酚;镇静;有效性;安全性
　　Clinical observation of rimazolom for painless gastroscopy sedation in outpatients
　　ZHANG Yi1，YE Gang2，ZHANG Liang3，LI Sitong1，XIANG Jun2，MOU Junying2，YAO Nana2，ZHU Xianlin2 （1. Graduate College， Hubei University of Medicine， Hubei Shiyan 442000， China; 2. Dept. of Anesthesiology， the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture， Hubei Enshi 445000， China; 3. Dept. of Anesthesiology， Chongqing Chinese Medicine Hospital， Chongqing 400021， China）
　　ABSTRACT OBJECTIVE To observe the efficacy and safety of rimazolom for painless gastroscopy sedation in outpatients. METHODS Totally 84 patients who underwent painless gastroscopy were collected from the outpatient department of the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from March to June in 2021. By random number table method combined with envelope allocation concealment method， they were randomly divided into observation group and control group， with 42 cases in each group. The patients in the observation group were slowly injected with Sufentanil citrate injection 0.1 μg/kg+Rimazole toluenesulfonate for injection 0.2 mg/kg. Patients in the control group were slowly injected with Sufentanil citrate injection 0.1 μg/kg+Propofol emulsion injection 2 mg/kg. Gastroscopy was performed after the patient’s consciousness disappeared. The sedative efficiency， sedative onset time， recovery time and the occurrence of adverse drug reaction were observed in 2 groups. The heart rate （HR）， mean arterial pressure （MAP）， pulse oxygen saturation （SpO2）， modified observer’s assessment of alertness/sedation （MOAA/S） score and Narcotrend score were recorded in 2 groups after entering the room （T0）， after anesthesia induction （T1）， when gastroscope entered the throat （T2）， at the end of gastroscope withdrawal （T3）， 5 min after gastroscopy （T4）. RESULTS There was no significant difference in the effective rate of sedation （100%）， the incidence of respiratory depression， nausea and vomiting between the two groups （P>0.05）. The onset time of sedation in the observation group was longer than control group， and the recovery time and the incidence of hypotension， hypotension to be treated， injection pain and bradycardia in observation group were significantly shorter or lower than control group （P<0.05）. At T0， there was no significant difference in HR， MAP， SpO2， MOAA/S score or Narcotrend score between two groups （P>0.05）. From T1 to T4， the HR of control group was significantly lower than that of the same group at T0， and significantly lower than observation group at the same time （P<0.05）. From T1 to T3， the MAP of two groups were significantly lower than the same group at T0 （P<0.05）， but there were no significant differences between two groups and between T4 and T0 （P>0.05）. There was no significant difference in SpO2 at different time points between two groups and HR at different time points in observation group （P>0.05）. From T1 to T3， MOAA/S score and Narcotrend score of two groups were significantly lower than the same group at T0， while the MOAA/S score and Narcotrend score at T1 and T3 and Narcotrend score at T3 of observation group were significantly higher than control group at the same time （P<0.05）， and the Narcotrend score of observation group at T2 was significantly lower than control group at the same time （P<0.05）; at T4， there were no significant differences in MOAA/S score and Narcotrend score between two groups （P>0.05）. CONCLUSIONS Remazolam shows good sedative effect and safety for painless gastroscopy.
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