瑞马唑仑与环泊酚复合瑞芬太尼用于老年超重患者无痛胃肠镜检查的麻醉效果

Anesthesia effect of remazolam or ciprofol combined with remifentanil for painless gastroscopy in elderly overweight patients

摘要:

目的 对比分析环泊酚+瑞芬太尼与瑞马唑仑+瑞芬太尼用于老年超重患者无痛胃肠镜检查的临床效果差异。方法 选择2023年10月－2024年10月计划于该院进行无痛胃肠镜检查的122例老年超重患者，并将其随机分为H组和R组，各61例。选择同期计划于该院进行无痛胃肠镜检查的122例老年正常体重患者，并将其随机分为H1组和R1组，各61例。所有对象均先给予瑞芬太尼0.5 μg/kg静脉注射，30 s后H组和H1组给予0.4 mg/kg环泊酚静脉注射，R组和R1组给予0.2 mg/kg瑞马唑仑静脉注射。比较4组患者麻醉效果和围手术期相关指标（检查时间、诱导时间等）。比较4组患者入室建立心电监护后即刻（T₀）、麻醉诱导完成即刻（T₁）、胃镜通过喉部时（T₂）、肠镜通过肝曲时（T₃）、术毕即刻（T₄）的血流动力学指标［平均动脉压（MAP）、心率（HR）和经皮动脉血氧饱和度（SpO₂）等］。比较4组患者不良反应发生情况。结果 麻醉优良率：H组和H1组均明显高于R组（96.72%、98.36%和86.89%，P < 0.05）。诱导时间：4组患者比较，差异无统计学意义（P > 0.05）。检查时间：H组、R组均明显长于H1组和R1组（P < 0.05），H组和R组比较，以及H1组和R1组比较，差异均无统计学意义（P > 0.05）。苏醒时间及离开麻醉恢复室（PACU）时间：H组、R组、H1组和R1组均逐渐缩短，各组两两比较，差异均有统计学意义（P < 0.05）。4组患者MAP、HR的组间、时间及交互效应比较，差异均有统计学意义（P < 0.05）；SpO₂的组间效应比较，差异有统计学意义（P < 0.05），时间及交互效应比较，差异均无统计学意义（P > 0.05）。注射痛发生率：H组和H1组均低于R组和R1组（P < 0.05）。其余各项不良反应的发生率：4组都无明显差异（P > 0.05）。结论 相较于瑞马唑仑+瑞芬太尼的组合，在老年超重患者实施无痛胃肠镜检查的过程中使用环泊酚+瑞芬太尼，能达到更出色的麻醉效果，且注射痛发生率更低。而老年正常体重患者两种麻醉方案的麻醉效果相当，但老年正常体重患者相对于老年超重患者，麻醉苏醒更快。

Abstract:

Objective To compare and analyze the application effects of ciprofol + remifentanil and remazolam + remifentanil in painless gastrointestinal gastroscopy in elderly overweight patients.Methods The subjects of this study, 122 elderly overweight patients for painless gastrointestinal endoscopy from October 2023 to October 2024, were randomly divided into H group and R group, each with 61 cases. At the same time, 122 elderly patients with normal body weight who planned to undergo painless gastrointestinal endoscopy during the same period were randomly divided into H1 group and R1 group, 61 cases in each group. All subjects received a slow intravenous injection of remifentanil at a dose of 0.5 μg/kg, 30 s later Group H and H1 group were administered with a slow intravenous injection of ciprofol at a dose of 0.4 mg/kg, while Group R and R1 group were given a slow intravenous injection of remazolam at a dose of 0.2 mg/kg. Anesthesia effect and perioperative indicators (examination time, induction time, etc.), and the hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR) and percutaneous arterial oxygen saturation (SpO₂)] were compared of the four groups immediately after the establishment of electrocardiogram monitoring (T₀), upon completion of anesthesia induction (T₁), when gastroscopy passed through the throat (T₂), when enteroscopy passed through the hepatic flexure (T₃), and immediately after completion of surgery (T₄), as well as adverse reactions were compared of the four groups.Results Excellent anesthesia rate: group H and H1 group were higher than group R (96.72%, 98.36% vs. 86.89%，P < 0.05). Induction time: no difference was found of the four groups (P > 0.05). Examination time: group H and group R were significantly longer than that in group H1 and group R1 (P < 0.05), but there was no significant difference between group H and group R, and between group H1 and group R1 (P > 0.05). The time of awakening and moving out of postanesthesia care unit (PACU): group H, group R, group H1 and group R1 gradually decreased, and the differences between each two groups were statistically significant (P < 0.05). There were statistically significant differences in MAP and HR of the four groups, time and interaction effects (P < 0.05). The difference of SpO₂ of the four groups was statistically significant (P < 0.05), and the difference of time and interaction effect was not statistically significant (P > 0.05). Incidence of injection pain: group H and group H1 were lower than group R and group R1 (P < 0.05). Incidence of other adverse reactions: no significant difference of four groups (P > 0.05).Conclusion During painless gastrointestinal endoscopy of elderly overweight patients the application of ciprofol + remifentanil can achieve better anesthetic effect and lower incidence of injection pain as compared with remazolam + remifentanil. The anesthetic effect of the two anesthesia regimens is similar in elderly normal weight patients, but the elderly normal weight patients have a faster recovery from anesthesia than the elderly overweight patients.