苯磺酸瑞马唑仑对行内镜逆行胰胆管造影术患者全身麻醉诱导期艾司氯胺酮半数有效量的影响

Effect of remimazolam besylate on the median effective dose of esketamine during the induction period of general anesthesia in patients undergoing endoscopic retrograde cholangiopancreatography

摘要:

目的 探究苯磺酸瑞马唑仑对行内镜逆行胰胆管造影术（ERCP）患者全身麻醉诱导期艾司氯胺酮半数有效量（ED50）的影响。方法 选取2024年3月－2025年1月于该院接受全身麻醉下ERCP的患者102例，通过分层随机分组，将患者分为R1组、R2组和R3组，各34例。比较3组患者麻醉诱导前（T₀）、内镜置入时（T₁）、十二指肠乳头切开时（T₂）、手术结束时（T₃）和术后10 min（T₄）的应激反应、血清疼痛介质和血流动力学指标。比较3组患者麻醉相关指标、艾司氯胺酮ED50及其95%CI和不良反应发生情况，并绘制艾司氯胺酮序贯图。分析不同苯磺酸瑞马唑仑剂量与全身麻醉下ERCP中诱导期艾司氯胺酮ED50的关系。结果 T₁、T₂、T₃和T₄时点，随着苯磺酸瑞马唑仑剂量的增加，3组患者的血管紧张素Ⅱ（Ang Ⅱ）、去甲肾上腺素（NE）、皮质醇（Cor）、前列腺素E2（PGE2）、P物质（SP）和神经肽Y（NPY）水平逐渐降低，但明显高于T₀时点，差异均有统计学意义（P < 0.05）；T₁、T₂和T₃时点，随着苯磺酸瑞马唑仑剂量的增加，3组患者的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）和经皮动脉血氧饱和度（SpO₂）水平逐渐升高，但明显低于T₀时点（P < 0.05）；随着苯磺酸瑞马唑仑剂量升高，3组患者的苏醒时间和离室时间逐渐缩短（P < 0.05）；R1组艾司氯胺酮ED50为0.539 mg/kg（95%CI：0.295～0.704），R2组艾司氯胺酮ED50为0.509 mg/kg（95%CI：0.267～0.695），R3组艾司氯胺酮ED50为0.443 mg/kg（95%CI：0.236～0.529）；与R1组相比，R2组和R3组使用艾司氯胺酮行ERCP的麻醉诱导ED50和95%药物有效剂量（ED95）明显降低，且R3组明显低于R2组，差异均有统计学意义（P < 0.05）。结论 复合苯磺酸瑞马唑仑0.300 mg/kg时，艾司氯胺酮用于全身麻醉下ERCP诱导的ED50为0.443 mg/kg。

Abstract:

Objective To investigate the effect of remimazolam besylate on esketamine median effective dose (ED50) during the induction period of endoscopic retrograde cholangiopancreatography (ERCP) under general anesthesia.Methods 102 patients who underwent ERCP under general anesthesia in our hospital from March 2024 to January 2025 were selected for the study. Through stratified random grouping, the patients were divided into R1 group, R2 group and R3 group, with 34 patients in each group. The stress responses, serum pain mediators, hemodynamic indicators before anesthesia induction (T₀), during endoscopic insertion (T₁), when the duodenal papilla is incised (T₂), at the end of the surgery (T₃), and 10 min after the operation (T₄) in three groups were compared; The anesthesia-related indicators, the ED50 of esketamine and 95% confidence interval (95%CI), and the occurrence of adverse reactions were compared. And draw the sequential diagram of esketamine. The relationship between different doses of remizazolam besylate and the ED50 of esketamine during the induction period of general anesthesia for ERCP was analyzed.Results At time points T₁, T₂, T₃, and T₄, as the dose of remimazolam besylate increased, the levels of angiotensin II (Ang Ⅱ), norepinephrine (NE), cortisol (Cor), prostaglandin E2 (PGE2), substance P (SP), and neuropeptide Y (NPY) in the three groups of patients gradually decreased, but were significantly higher than those at the T₀ time point, and the differences were statistically significant (P < 0.05). At time points T₁, T₂ and T₃, as the dose of remimazolam besylate increased, the mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and percutaneous arterial oxygen saturation (SpO₂) levels of the three groups of patients gradually rose, but were significantly lower than those at the T₀ time point (P < 0.05). As the dose of remimazolam besylate increased, the awakening time and the time to leave the room for the patients in all three groups gradually shortened (P < 0.05). The ED50 of esketamine in group R1 was 0.539 mg/kg (95%CI: 0.295 ~ 0.704), in group R2 it was 0.509 mg/kg (95%CI: 0.267 ~ 0.695), and in group R3 it was 0.443 mg/kg (95%CI: 0.236 ~ 0.529). Compared with the R1 group, the anesthesia induction ED50 and 95% drug effective dose (ED95) for ERCP using esketamine in the R2 and R3 groups were significantly lower, and the R3 group was significantly lower than the R2 group. The differences were statistically significant (P < 0.05).Conclusion When using compound remimazolam besylate 0.300 mg/kg, the ED50 of esketamine for inducing ERCP under general anesthesia was 0.443 mg/kg.