瑞马唑仑复合阿芬太尼在老年患者无痛胃肠镜检查中的临床效果与安全性分析

Clinical effect and safety analysis of remimazolam combined with alfentanil in painless gastroenteroscopy in elderly patients

摘要:

目的 探讨瑞马唑仑复合阿芬太尼在老年患者无痛胃肠镜检查中的临床效果与安全性。方法 选择2021年10月－2023年2月该院拟行无痛胃肠镜检查的老年患者188例，采用随机数表法分为A组、B组、C组和D组，各47例。A组、B组和C组分别采用瑞马唑仑0.2、0.3和0.4 mg/kg+阿芬太尼3 μg/kg，术中追加药物，给予瑞马唑仑2.5 mg/次；D组采用丙泊酚1.5 mg/kg + 阿芬太尼3 μg/kg，术中追加药物，单次给予丙泊酚0.5 mg/kg。比较4组不同时间点［麻醉给药前3 min（T₀）、进镜即刻（T₁）、进镜后3 min（T₂）、检查结束时（T₃）和苏醒时（T₄）］血流动力学情况、麻醉起效时间、镇静成功率、胃肠镜检查时间、苏醒时间、离开观察室时间、术中/术后并发症和神经行为认知状态测试（NCSE）情况。结果 A组T₁和T₂时点经皮动脉血氧饱和度（SpO₂）高于C组和D组，差异均有统计学意义（P < 0.05）；A组、B组、C组及D组各时间点心率（HR）和平均动脉压（MAP）比较，差异均无统计学意义（P > 0.05）；A组与B组各时间点SpO₂比较，差异无统计学意义（P > 0.05）；4组镇静成功率、胃肠镜检查时间和离开观察室时间比较，差异均无统计学意义（P > 0.05），A组麻醉起效时间长于B组、C组和D组，A组和B组苏醒时间短于C组和D组，差异均有统计学意义（P < 0.05），A组苏醒时间与B组比较，差异无统计学意义（P > 0.05）；A组和B组心动过缓发生率低于D组，A组低氧血症、呼吸抑制、低血压和头晕发生率低于D组，A组、B组和C组注射痛发生率低于D组，差异均有统计学意义（P < 0.05）；完全清醒后10 min，A组与B组计算能力和记忆力测试通过率比较，差异无统计学意义（P > 0.05），但A组计算能力与记忆力测试通过率高于C组和D组，差异均有统计学意义（P < 0.05）。结论 在老年患者行无痛胃肠镜检查时，采用0.3 mg/kg瑞马唑仑复合阿芬太尼的镇静效果较佳，患者血流动力学平稳，心动过缓和呼吸抑制等并发症发生率低，术后早期认知功能恢复良好。

Abstract:

Objective To explore the clinical effect and safety of remimazolam combined with alfentanil in painless gastroenteroscopy in elderly patients.Methods 188 elderly patients who were scheduled to undergo painless gastroenteroscopy from October 2021 to February 2023 were selected and divided into group A, group B, group C, and group D by random number table method, with 47 cases in each group. The group A, group B and group C were used remimazolam 0.2, 0.3 and 0.4 mg/kg, and alfentanil 3 μg/kg respectively, and the remimazolam 2.5 mg/time was added during the operation. The group D was used propofol 1.5 mg/kg and alfentanil 3 μg/kg, and a single dose of propofol 0.5 mg/kg was added during the operation. The hemodynamics at different time points [3 min before anesthesia administration (T₀), immediately after endoscopy (T₁), 3 min after endoscopy (T₂), at the end of examination (T₃), at the time of awakening (T₄)], anesthesia onset time, sedation success rate, gastrointestinal endoscopy time, awakening time, time to leave the observation room and intraoperative/postoperative complications were compared, and the test results of neurobehavioral cognitive state examination (NCSE) were compared at different times.Results The percutaneous arterial oxygen saturation (SpO₂) at T₁ and T₂ time point were higher than group C and group D, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in the heart rate (HR) and mean arterial pressure (MAP) among group A, group B, group C and group D at each time point (P > 0.05). There was no statistically significant difference in SpO₂ between group A and group B at each time point (P > 0.05). There was no statistically significant difference in the success rate of sedation, gastrointestinal endoscopy examination time and time of leaving the observation room among the four groups (P > 0.05), but the onset time of anesthesia in group A was longer than that in group B, group C and group D, and the awakening time in group A and group B was shorter than that in group C and group D, and the differences were statistically significant (P < 0.05). There was no statistically significant difference in awakening time between group A and group B (P > 0.05). The incidence rate of bradycardia in group A and group B was lower than in group D, and the incidence rates of hypoxemia, respiratory depression, hypotension, and dizziness in group A were lower than those in group D, and the incidence rate of injection pain in group A, group B and group C was lower than that in group D, and the differences were statistically significant (P < 0.05). After 10 minutes of complete wakefulness, there was no statistically significant difference in the passing rates of calculation ability and the memory tests between group A and group B (P > 0.05), but the passing rates of calculation ability and memory test in group A were higher than those in group C and group D, and the differences were statistically significant (P < 0.05).Conclusion During painless gastroenteroscopy in elderly patients, the sedative effect of using 0.3 mg/kg remimazolam combined with alfentanil is good, and it has stable hemodynamics, and the occurrence rate of complications such as bradycardia and espiratory depression is low, and the early postoperative cognitive function is recovered well.