瑞马唑仑用于老年患者无痛消化道内镜检查的安全性与可行性的Meta分析

A Meta-analysis of the safety and feasibility of remimazolam for painless gastrointestinal endoscopy in elderly patients

摘要:

目的 系统评价瑞马唑仑用于老年患者无痛消化道内镜检查的镇静效果和麻醉安全性。方法 根据Meta分析的原则，全面检索PubMed、The Cochrane Library、Embase、中国生物医学文献数据库、中国知网和万方数据中有关瑞马唑仑用于老年患者无痛消化道内镜检查的随机对照试验（RCT），检索时间截止至2022年5月。筛选和提取所需资料，并使用Cochrane协作网偏倚风险评价工具，对纳入研究的质量进行评估，使用RevMan 5.4.1软件对结局指标进行Meta分析。结果 共12篇RCT（1 296例患者）纳入分析。其中，瑞马唑仑组（R组）647例，丙泊酚组（P组）649例。瑞马唑仑组患者心率（HR）（WMD = 0.40，95%CI：-0.49～1.28，P = 0.380）和平均动脉压（MAP）（WMD = 5.05，95%CI：-3.83～13.93，P = 0.260）的变化幅度与丙泊酚组比较，差异无统计学意义。麻醉期间，瑞马唑仑组低血压发生率（RR＾ = 0.24，95%CI：0.15～0.39，P = 0.000）、呼吸抑制发生率（RR＾ = 0.28，95%CI：0.18～0.44，P = 0.000）、恶心呕吐发生率（RR＾ = 0.70，95%CI：0.50～0.99，P = 0.050）和注射疼痛发生率（RR＾ = 0.03，95%CI：0.01～0.08，P = 0.000）均低于丙泊酚组。瑞马唑仑组麻醉诱导后麻醉起效时间较丙泊酚组更长（WMD = 0.23，95%CI：0.11～0.34，P = 0.000），但苏醒时间较丙泊酚组短（WMD = -1.06，95%CI：-1.25～-0.87，P = 0.000）。结论 瑞马唑仑用于老年患者无痛消化道内镜检查的麻醉诱导，循环稳定，不良反应较少，是一种安全可靠的麻醉方案。

Abstract:

Objective To systematically evaluate the sedative effect and anesthesia safety of remazolam in elderly patients underwent painless gastrointestinal endoscopy.Methods According to the principle of Meta-analysis, we comprehensively searched PubMed database, The Cochrane Library, Embase database, China Biology Medicine database (CBM), China National Knowledge Infrastructure (CNKI) and Wanfang database for randomized controlled trials (RCT) of remimazolam for painless gastrointestinal endoscopy in the elderly up to May 2022. The required data were screened and extracted, and the quality of the included studies was evaluated using the Cochrane Collaboration evaluation tool. Meta-analysis of outcome indicators was performed using RevMan 5.4.1 software.Results Twelve clinical trials (1 296 patients) were included in the analysis, including 647 patients in the remimazolam group (group R) and 649 patients in the propofol group (group P). There was no significant difference in heart rate (HR) (WMD = 0.40, 95%CI: -0.49~1.28, P = 0.380) and mean arterial pressure (MAP) (WMD = 5.05, 95%CI: -3.83 ~ 13.93, P = 0.260) between the two groups. During the anesthesia, the incidence rate of hypotension (RR＾ = 0.24, 95%CI: 0.15 ~ 0.39, P = 0.000), respiratory depression (RR＾ = 0.28，95%CI：0.18 ~ 0.44，P = 0.000), nausea and vomiting (RR＾ = 0.70, 95%CI: 0.50 ~ 0.99, P = 0.050), injection pain (RR＾ = 0.03，95%CI：0.01 ~ 0.08，P = 0.000) in the remimazolam group were lower than those in the propofol group. The anesthesia onset time after anesthesia induction in the remifentanil group was longer than that in the propofol group (WMD = 0.23, 95%CI: 0.11 ~ 0.34, P = 0.000), but the recovery time was significantly shorter than that in the propofol group (WMD = -1.06, 95%CI: -1.25 ~ 0.87, P = 0.000).Conclusion Remimazolam is a safe and reliable anesthesia regimen for the induction of painless gastrointestinal endoscopy in the elderly, with stable circulation and minimal adverse reactions.