艾司氯胺酮与阿芬太尼复合瑞马唑仑在老年患者支气管镜检查中的应用效果对比

Comparison of the application effects of esketamine and alfentanil combined with remimazolam in elderly undergoing bronchoscopy patients

摘要:

目的 比较老年患者支气管镜检查中，艾司氯胺酮与阿芬太尼复合瑞马唑仑的麻醉效果，以及对患者认知功能的影响。方法 选择2023年1月－2025年1月拟在武威市人民医院行支气管镜检查的老年患者106例，随机分为两组，各53例。其中，艾司氯胺酮组给予0.25 mg/kg艾司氯胺酮+0.20 mg/kg瑞马唑仑进行麻醉诱导，阿芬太尼组给予阿芬太尼10 μg/kg复合瑞马唑仑0.20 mg/kg进行麻醉诱导，两组均给予瑞马唑仑1 mg/（kg·h）进行麻醉维持。检查结束后，评估两组患者麻醉效果。比较两组患者麻醉诱导前即刻（T₀）、诱导结束后即刻（T₁）、支气管镜至声门（T₂）、支气管镜至隆突（T₃）和检查结束即刻（T₄）的血流动力学指标。比较两组患者一次喉罩置入成功率、麻醉诱导时间、苏醒时间和检查时间。术前和麻醉苏醒后30 min，采用40项恢复质量量表（QoR-40）评分，评估患者麻醉后恢复质量。术前和麻醉苏醒后1 h，采用简易精神状态检查（MMSE）评分，评估患者认知功能。比较两组患者不良反应的发生情况。结果 艾司氯胺酮组麻醉优良率为96.23%，明显高于阿芬太尼组的84.91%，差异有统计学意义（P 0.05）。艾司氯胺酮组T₁、T₂、T₃和T₄时点的MAP明显高于同期阿芬太尼组，T₁和T₂时点的心率（HR）明显高于同期阿芬太尼组，T₁、T₂和T₃时点的经皮动脉血氧饱和度（SpO₂）明显高于同期阿芬太尼组，差异均有统计学意义（P 0.05）。两组患者一次喉罩置入成功率和检查时间比较，差异均无统计学意义（P 0.05）。艾司氯胺酮组麻醉诱导时间和苏醒时间明显短于阿芬太尼组，差异均有统计学意义（P 0.05）。麻醉苏醒后30 min，艾司氯胺酮组QoR-40评分中，各维度评分和总分与术前比较，差异均无统计学意义（P 0.05），阿芬太尼组QoR-40评分中，各维度（除心理支持维度外）评分和总分低于术前，且明显低于艾司氯胺酮组，差异均有统计学意义（P 0.05）。除艾司氯胺酮组MMSE中的语言评分外，两组患者麻醉苏醒后1 h的MMSE评分，各项内容评分和总分均明显低于同组术前，且阿芬太尼组明显低于艾司氯胺酮组，差异均有统计学意义（P 0.05）。艾司氯胺酮组低血压和呼吸抑制发生率明显低于阿芬太尼组，差异均有统计学意义（P 0.05）。结论 相对于阿芬太尼复合瑞马唑仑，艾司氯胺酮复合瑞马唑仑应用于老年患者支气管镜检查，能取得更好的麻醉效果，且对患者的认知功能影响更小。值得应用于临床。

Abstract:

Objective To compare the anesthetic effects of esketamine combined with alfentanil and remimazolam during bronchoscopy in elderly patients, as well as their influences on cognitive function.Methods 106 elderly patients who were scheduled to undergo bronchoscopy from January 2023 to January 2025 were selected and randomly divided into two groups, with 53 cases in each group. Among them, the esketamine group was given 0.25 mg/kg esketamine + 0.20 mg/kg remimazolam for anesthesia induction, while the alfentanil group was given 10 μg/kg of alfentanil combined with 0.20 mg/kg remimazolam for anesthesia induction. Both groups were given 1 mg/(kg·h) of remimazolam for anesthesia maintenance. After the examination, the anesthetic effects of the two groups of patients were evaluated. The hemodynamic indicators of the two groups of patients were compared immediately before anesthesia induction (T₀), immediately after induction (T₁), from bronchoscopy to the glottis (T₂), from bronchoscopy to the carina (T₃), and immediately after the examination (T₄). The success rate of one-time laryngeal mask placement, anesthesia induction time, recovery time and examination time of the two groups of patients were compared. Before the operation and 30 minutes after anesthesia recovery, the quality of recovery of patients after anesthesia was evaluated using the 40-item quality of recovery scale (QoR-40) scores. Before the operation and 1 hour after anesthesia recovery, the cognitive function of the patients was evaluated using the mini-mental state examination (MMSE) scores. Compare the occurrence of adverse reactions between the two groups of patients.Results The excellent and good rates of anesthesia in the esketamine group were 96.23%, significantly higher than 84.91% in the alfentanil group, and the difference was statistically significant (P 0.05). The MAP at time points T₁, T₂, T₃ and T₄ in the esketamine group were significantly higher than those in the alfentanil group at the same period. The heart rate (HR) at time points T₁ and T₂ was significantly higher than that in the alfentanil group at the same period. The percutaneous arterial oxygen saturation (SpO₂) at time points T₁, T₂, and T₃ was significantly higher than that in the alfentanil group at the same period. The differences were all statistically significant (P 0.05). There were no statistically significant differences in the success rate of one-time laryngeal mask placement and the examination time between the two groups of patients (P 0.05). The anesthesia induction time and recovery time in the esketamine group were significantly shorter than those in the alfentanil group, and the differences were statistically significant (P 0.05). Thirty minutes after anesthesia alfentanil, there were no statistically significant differences in the scores of each dimension and the total QoR-40 scores in the esketamine group compared with those before the operation (P 0.05). The scores of each dimension (excepting the psychological support dimension) and the total QoR-40 scores in the alfentanil group were lower than those before the operation and significantly lower than those in the esketamine group, the differences were all statistically significant (P 0.05). Excepting for the language score in the MMSE of the esketamine group, the scores of each item and the total MMSE scores of the two groups of patients 1 hour after anesthesia recovery were significantly lower than those before the operation, and the alfentanil group was significantly lower than the esketamine group. The differences were statistically significant (P 0.05). The incidences of hypotension and respiratory depression in the esketamine group were significantly lower than those in the alfentanil group, and the differences were statistically significant (P 0.05).Conclusion Esketamine combined with remimazolam, compared with alfentanil combined with remimazolam, can achieve better anesthetic effects when applied to bronchoscopy in elderly patients, and has a smaller impact on the cognitive function of patients. It is worth applying in clinical practice.