瑞马唑仑联合瑞芬太尼在老年患者无痛支气管镜检查中对血液动力学的影响

Effect of remimazolam combined with remifentanil on hemodynamics in elderly patients undergoing painless bronchoscopy

摘要:

目的 探讨瑞马唑仑联合瑞芬太尼用于老年患者无痛支气管镜检查的效果，并观察其对血液动力学的影响。方法 选取2021年10月－2022年10月在该院住院的80例接受支气管镜检查的老年患者作为研究对象，根据不同麻醉方式，分为瑞芬太尼组和联合组。瑞芬太尼组给予瑞芬太尼辅助支气管镜检查，联合组在瑞芬太尼组基础上联合瑞马唑仑辅助支气管镜检查。比较两组患者不同时点［麻醉诱导前（T₁）、纤维支气管镜通过声门时（T₂）、通过声门后1 min时（T₃）、通过声门后5 min时（T₄）和检查结束时（T₅）］血流动力学变化和手术情况，观察不同麻醉方式患者术中及术后不良反应发生情况，并进行满意度分析。结果 与瑞芬太尼组相比，联合组心率（HR）在T₂、T₃和T₄时点较慢；经皮动脉血氧饱和度（SpO₂）在T₃和T₄时点较低；舒张压（DBP）和收缩压（SBP）在T₂、T₃和T₄时点较高，差异均有统计学意义（P < 0.05）；联合组药物起效时间短，患者苏醒时间长，低氧血症、低血压和HR减慢发生率低，HR增快发生率高，术后满意度高，差异均有统计学意义（P < 0.05）；两组患者术后恶心呕吐、头晕头痛和嗜睡乏力发生率比较，差异均无统计学意义（P > 0.05）。结论 瑞马唑仑联合瑞芬太尼用于老年患者无痛支气管镜检查，有较好的临床应用效果，能够维持患者血流动力学稳定，且起效快，药效作用时间久，术中不良反应发生率低，有较高的安全性，可提高患者满意度。

Abstract:

Objective To explore the effect of remimazolam combined with remifentanil on painless bronchoscopy in elderly patients and observe its impact on hemodynamics.Methods Collect 80 elderly patients underwent bronchoscopy examination from October 2021 to October 2022 as research subjects, and divide them into remifentanil group and combination group according to anesthesia methods. Remifentanil group was given remifentanil assisted painless bronchoscopy, and the combined group was given remimazolam assisted painless bronchoscopy based on remifentanil group. The hemodynamics and operation conditions of the two groups at different time points [before anesthesia induction (T₁), at the time of transglottis (T₂), 1 min after transglottis (T₃), 5 min after transglottis (T₄) , at the end of the inspection (T₅)] were compared, and the changes of intraoperative and postoperative adverse reactions of patients with different anesthesia methods were observed, and satisfaction analysis was conducted.Results Compared with remifentanil group, the heart rate (HR) in the combined group at T₂, T₃, and T₄ was slower, percutaneous arterial oxygen saturation (SpO₂) was lower at T₃, T₄, diastolic blood pressure (DBP) and systolic blood pressure (SBP) were higher in T₂, T₃, T₄, and the differences were statistically significant (P < 0.05). The onset time of drugs was shorter, the recovery time of patients was long, the incidence of hypoxemia, hypotension and HR slowdown was lower, the incidence of HR increased was higher, and the postoperative satisfaction was higher, with statistical significance (P < 0.05). There was no statistically significant difference in the incidence of postoperative nausea, vomiting, dizziness, headache, and drowsiness between the two groups of patients (P > 0.05).Conclusion Remimazolam combined with remifentanil for painless bronchoscopy in elderly patients may have a good application effect, which can maintain hemodynamic stability, rapid onset, long duration of efficacy, reduce the rate of intraoperative adverse reactions, have a good safety, and can improve patient satisfaction.