不同剂量瑞马唑仑在老年肥胖患者无痛胃镜检查中的效果比较

Comparative of the effects of different doses of remifentanil in painless gastroscopy for the aged obese

摘要:

目的 探究不同剂量瑞马唑仑用于老年肥胖患者无痛胃镜检查的临床效果。方法 选择2024年1月－2024年6月于该院择期行无痛胃镜检查的老年肥胖患者160例。采用随机数表法分组：P组（丙泊酚，40例）、R1组（瑞马唑仑0.20 mg/kg，40例）、R2组（瑞马唑仑0.30 mg/kg，40例）和R3组（瑞马唑仑0.40 mg/kg，40例）。对比4组患者麻醉相关情况和不良反应发生率；记录4组患者麻醉诱导前、进镜3 min后和检查结束时的血流动力学指标。结果 与P组和R1组相比，R2组和R3组镇静起效时间更短，差异均有统计学意义（P < 0.05）；R3组苏醒时间长于P组、R1组和R2组，差异均有统计学意义（P < 0.05）；与P组和R3组相比，R1组和R2组恢复室观察时间更短，差异均有统计学意义（P < 0.05）；与P组和R1组相比，R2组和R3组补救镇静次数更少，差异均有统计学意义（P < 0.05）。4组患者诱导前、进镜3 min后和检查结束时心率（HR）、收缩压（SBP）、舒张压（DBP）和经皮动脉血氧饱和度（SpO₂）比较，差异均无统计学意义（P > 0.05）。P组低血压、呼吸抑制、注射痛和心动过缓发生率明显高于R1组、R2组和R3组，差异均有统计学意义（P < 0.05），R1组、R2组和R3组低血压、呼吸抑制、注射痛和心痛过缓发生率比较，差异均无统计学意义（P > 0.05）。结论 瑞马唑仑用于老年肥胖患者无痛胃镜检查，较丙泊酚可以降低不良反应发生率。当瑞马唑仑剂量达到0.30 mg/kg时，即可缩短麻醉起效时间和恢复室观察时间，减少补救镇静次数。值得应用于临床。

Abstract:

Objective To explore the clinical effects of different doses of remimazolam in painless gastroscopy for the aged obese.Methods 160 aged obese patients who were scheduled to undergo painless gastroscopy from January 2024 to June 2024 were selected. The random number method was used for grouping: group P (propofol, 40 cases), group R1 (remimazolam 0.20 mg/kg, 40 cases), group R2 (remimazolam 0.30 mg/kg, 40 cases), and group R3 (remimazolam 0.40 mg/kg, 40 cases). Compare the anesthesia-related conditions and the incidence of adverse reactions among the four groups of patients; The hemodynamic indicators of the four groups of patients before anesthesia induction, 3 minutes after endoscopy insertion and at the end of the examination were recorded.Results Compared with group P and group R1, the onset time of sedation in group R2 and group R3 was shorter, and the differences were statistically significant (P < 0.05). The recovery time of group R3 was longer than that of group P, group R1 and group R2, and the differences were statistically significant (P < 0.05). Compared with group P and group R3, the observation time in the recovery room of group R1 and group R2 was shorter, and the differences were statistically significant (P < 0.05). Compared with group P and group R1, group R2 and group R3 had fewer times of remedial sedation, and the differences were statistically significant (P < 0.05). There were no statistically significant differences in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and percutaneous arterial oxygen saturation (SpO₂) among the four groups of patients before induction, 3 minutes after endoscopy insertion, and at the end of the examination (P > 0.05). The incidences of hypotension, respiratory depression, injection pain and bradycardia in group P were significantly higher than those in group R1, group R2 and group R3, and the differences were statistically significant (P < 0.05). There were no statistically significant differences in the incidences of hypotension, respiratory depression, injection pain and bradycardia among group R1, group R2 and group R3 (P > 0.05).Conclusion Remimazolam used for painless gastroscopy in the aged obese patients can reduce the incidence of adverse reactions compared with propofol. When the dose of remifentanil reaches 0.30 mg/kg, the onset time of anesthesia and the observation time in the recovery room can be shortened, and the number of remedial sedations can be reduced. It is worth applying in clinical practice.