阿芬太尼与艾司氯胺酮联合瑞马唑仑在老年患者无痛胃肠镜检查中的麻醉效果比较：一项随机对照试验

Comparison of anesthetic effects of alfentanil versus esketamine combined with remimazolam during painless gastrointestinal endoscopy in elderly patients: a randomized controlled trial

摘要:

目的 比较瑞马唑仑联合阿芬太尼或艾司氯胺酮在老年患者无痛胃肠镜检查中的麻醉有效性及安全性。方法 选取2024年10月－2025年7月于该院进行无痛胃肠镜检查的老年患者200例，随机分为瑞马唑仑联合阿芬太尼组（RA组，n = 100）和瑞马唑仑联合艾司氯胺酮组（RE组，n = 100）。观察患者操作过程中的体动反应发生率、医生满意度、苏醒时间、定向力恢复时间、离室时间、血流动力学指标和不良反应发生率。结果 RE组体动反应发生率明显低于RA组（5.0%和19.0%），内镜医师操作满意度评分明显高于RA组，差异均有统计学意义（P 0.05）。RE组检查过程中的平均动脉压（MAP）和心率（HR）更加稳定，低血压（5.0%和15.0%）和呼吸抑制（3.0%和12.0%）发生率明显低于RA组，差异均有统计学意义（P 0.05）。两组患者苏醒时间、定向力恢复时间、离室时间和其他并发症发生率比较，差异均无统计学意义（P 0.05）。结论 在老年患者进行无痛胃肠镜检查的过程中，相比于瑞马唑仑联合阿芬太尼，瑞马唑仑联合艾司氯胺酮，能够提供更好的镇痛效果和操作条件，且血流动力学更加稳定，安全性更高。值得应用于临床。

Abstract:

Objective To compare the efficacy and safety of remimazolam combined with alfentanil or esketamine for sedation during painless gastrointestinal endoscopy in elderly patients.Methods 200 elderly patients undergoing painless gastrointestinal endoscopy from October 2024 to July 2025 were selected and randomly divided into a remimazolam and alfentanil combination group (RA group, n = 100) and a remimazolam and esketamine combination group (RE group, n = 100). The incidence of body movement reactions, physician satisfaction, awakening time, orientation restoration time, discharge from the recovery room time, hemodynamic parameters, and incidence of adverse reactions were observed during the procedure.Results The incidence of body movement reactions in the RE group was significantly lower than that in the RA group (5.0% vs. 19.0%), and the endoscopic physician satisfaction score was also significantly higher in the RE group, the difference was statistically significant (P 0.05). During the procedure, the RE group maintained more stable mean arterial pressure (MAP) and heart rate (HR), with significantly lower incidences of hypotension (5.0% vs. 15.0%) and respiratory depression (3.0% vs. 12.0%) compared to the RA group, the differences were statistically significant (P 0.05). There were no statistically significant differences between the two groups in awakening time, orientation restoration time, and other complications incidence rate (P 0.05).Conclusion In the process of painless gastrointestinal endoscopy for elderly patients, remimazolam combined with esketamine provides superior analgesia and procedural conditions compared to remimazolam combined with alfentanil, significantly enhancing hemodynamic stability and improving safety. It is a worthy clinical application.