长江大学附属第一医院(荆州市第一人民医院) 麻醉科，湖北 荆州 434000
Department of Anesthesiology, the First Affiliated Hospital of Yangtze University (the First People’s Hospital of Jingzhou), Jingzhou, Hubei 434000, China
目的 探讨甲苯磺酸瑞马唑仑复合小剂量丙泊酚在无痛胃镜诊疗中的安全性和有效性。方法 选取150例择期行无痛胃镜的患者，随机分为3组（n = 50）：甲苯磺酸瑞马唑仑组（R组）、丙泊酚组（B组）和甲苯磺酸瑞马唑仑复合丙泊酚组（RB组）。R组和B组分别静脉给予甲苯磺酸瑞马唑仑0.20 mg/kg和丙泊酚2.00 mg/kg，RB组依次静脉给予甲苯磺酸瑞马唑仑0.15 mg/kg及丙泊酚0.50 mg/kg，30～40 s内缓慢推注，均于用药前5 min使用芬太尼1 μg/kg预镇痛进行静脉麻醉。睫毛反射消失之后，由同一医师进行内镜操作。记录并比较3组患者镇静成功率、体动情况和围术期不良事件，以及3组患者诱导起效时间、唤醒时间、离室时间。结果 3组患者镇静均未失败，成功率为100.0%。RB组术中体动发生率（8.0%）低于R组（28.0%），与B组（4.0%）比较，差异无统计学意义（P > 0.05）。RB组低血压、心动过缓和低氧血症发生率均低于B组（P < 0.05），与R组比较，差异无统计学意义（P > 0.05）。RB组的注射痛发生情况少于B组（P < 0.05），与R组比较，差异无统计学意义（P > 0.05）。术后恶心、呕吐及头晕方面，3组患者比较，差异无统计学意义（P > 0.05）。RB组诱导起效时间较R组短（P < 0.05），与B组相比，诱导起效时间长（P < 0.05）。3组患者唤醒时间和离室时间比较，差异无统计学意义（P > 0.05）。结论 甲苯磺酸瑞马唑仑复合小剂量丙泊酚的安全性及有效性优于两者单独使用，应用于无痛胃镜诊疗有重要的临床价值。
Objective To explore the efficacy and safety of Remimazolam tosylate combined with low-dose Propofol in painless gastroscopy.Methods 150 patients scheduled for painless gastroscopy, were randomly divided into 3 groups (n = 50): Remimazolam group (group R), Propofol group (group B), and the Remimazolam combined with Propofol group (Group RB). Group R was given 0.20 mg/kg of Remimazolam tosylate intravenously, group B was given 2.00 mg/kg of Propofol intravenously, and group RB was given 0.15 mg/kg of Remimazolam tosylate and 0.50 mg/kg of Propofol intravenously. All group injected slowly at 30 ~ 40 s and use Fentanyl 1 μg/kg for intravenous analgesia. Gastroscopy was performed by the same physician when the eyelash reflex disappeared. The success rate of sedation, body movement and the perioperative adverse events were recorded, and the induction time, emergence time and discharge time were compared.Results The success rate of sedation was 100.0% in all the three groups. The incidence of intraoperative body movement in group RB (8.0%) was lower than that in group R (28.0%), and there was no difference between group RB and group B (4.0%). The rates of hypotension, bradycardia and hypoxemia in group RB were lower than that in group B, and did not differ from that in group R. The rate of injection pain in group RB was lower than that in group B, and there was no difference between group RB and group R. There was no significant difference in the incidence of postoperative nausea, vomiting and dizziness among the three groups. The induction time of group RB was shorter than that of group R (P < 0.05) and slightly longer than that of group B (P < 0.05). There was no difference in emergence time and discharge time among the three groups.Conclusion The safety and efficacy of Remimazolam tosylate combined with low-dose Propofol is better than that of both alone and it has important clinical value in the painless gastroscopy.