摘要
目的探讨老年无痛胃镜检查中联合使用阿芬太尼、甲苯磺酸瑞马唑仑的镇静镇痛效果。方法选取行无痛胃镜检查的老年患者500例,按随机数字表法分为R1组和P组,各250例。R1组行甲苯磺酸瑞马唑仑+阿芬太尼麻醉,P组使用阿芬太尼+丙泊酚麻醉。对比两组患者各项生命指标[平均动脉压(MAP)、心率(HR)、呼吸频率(RR)]、有效性指标[总检查时间、苏醒时间、苏醒至离开手术室时间、Ramsay镇静评分、非插管患者行为疼痛量表(BPS-NI)评分]、不良反应发生情况。结果P组患者诱导前以及诱导后1、9、20 min的MAP分别为(96.58±12.54)、(80.45±12.06)、(78.95±14.26)、(81.63±11.87)mm Hg(1 mm Hg=0.133 kPa),HR分别为(80.96±13.65)、(62.89±13.04)、(62.50±11.57)、(62.89±10.37)次/min,RR分别为(19.85±1.89)、(12.20±3.26)、(15.04±2.12)、(16.52±1.78)次/min;R1组患者诱导前以及诱导后1、9、20 min的MAP分别为(96.87±13.43)、(84.40±12.89)、(84.10±12.37)、(85.52±12.66)mm Hg,HR分别为(81.15±13.48)、(72.64±14.21)、(72.41±13.57)、(72.64±12.10)次/min,RR分别为(19.92±1.84)、(15.96±2.39)、(16.32±1.04)、(17.85±1.88)次/min。与诱导前相比,两组患者诱导后1、9、20 min的MAP、HR、RR均发生不同程度下降,但R1组MAP、HR、RR均高于P组,有统计学差异(P<0.05)。R1组总检查时间(7.74±2.55)min、苏醒时间(5.94±0.97)min、苏醒至离开手术室时间(25.79±4.16)min均短于P组的(8.42±2.69)、(9.88±2.21)、(30.26±4.52)min,BPS-NI评分(3.85±0.64)分低于P组的(7.21±1.26)分,留置针穿刺时及检查结束时Ramsay镇静评分(3.75±0.57)、(2.68±0.41)分均高于P组的(2.75±0.35)、(2.04±0.27)分,有统计学差异(P<0.05)。R1组低血压、低氧血症、恶心、呛咳、头晕、注射痛、呕吐发生率分别为10.80%、6.80%、2.00%、2.80%、2.80%、2.00%、0.80%,均低于P组的22.00%、18.00%、8.80%、10.00%、10.00%、14.00%、11.20%,有统计学差异(P<0.05)。结论老年无痛胃镜检查中联合使用阿芬太尼、甲苯磺酸瑞马唑仑镇静镇痛效果更好,能维持生命体征平稳,缩短患者苏醒时间、离室时间与检查时间,且不良反应少,可提高检查安全性。
Objective To explore the sedative and analgesic effect of alfentanil combined with remimazolam tosilate in elderly patients undergoing painless gastroscopy.Methods A total of 500 elderly patients underwent painless gastroscopy were divided into group R1 and group P according to random number table method,each with 250 patients.Group R1 was anesthetised with remimazolam tosilate+alfentanil,while group P was anesthetised with alfentanil+propofol.Patients in both groups were compared in terms of vital indicators[mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)],effectiveness indicators[total time of examination,wake-up time,time from awakening to leaving the operating room,Ramsay sedation score,Behavioral Pain Scale for non-intubated patients(BPS-NI)score]and the occurrence of adverse reactions.Results In group P,MAP before induction and 1,9 and 20 min after induction were(96.58±12.54),(80.45±12.06),(78.95±14.26)and(81.63±11.87)mm Hg(1 mm Hg=0.133 kPa),HR were(80.96±13.65),(62.89±13.04),(62.50±11.57)and(62.89±10.37)beats/min,and RR were(19.85±1.89),(12.20±3.26),(15.04±2.12)and(16.52±1.78)times/min.In group R1,MAP before induction and 1,9 and 20 min after induction were(96.87±13.43),(84.40±12.89),(84.10±12.37)and(85.52±12.66)mm Hg,HR were(81.15±13.48),(72.64±14.21),(72.41±13.57)and(72.64±12.10)beats/min,and RR were(19.92±1.84),(15.96±2.39),(16.32±1.04)and(17.85±1.88)times/min.Compared with before induction,MAP,HR,and RR in both groups decreased to varying degrees at 1,9,and 20 min(80.45±12.06)、(78.95±14.26)、(81.63±11.87)mm Hg,after induction,but BP,HR,and RR of group R1 were higher than those of group P,and there was a statistical difference(P<0.05).In group R1,the total time of examination was(7.74±2.55)min,the wake-up time was(5.94±0.97)min,and the time from awakening to leaving the operating room was(25.79±4.16)min,which were all shorter than(8.42±2.69),(9.88±2.21)and(30.26±4.52)min in group P;group R1 had lower BPS-NI score of(3.85±0.64)points than(7.21±1.26)points in group P;the Ramsay sedation scores at the time of indwelling needle puncture and at the end of the examination in group R1 were(3.75±0.57)and(2.68±0.41),which were higher than(2.75±0.35)and(2.04±0.27)in group P;there was a statistical difference(P<0.05).The incidence of hypotension,hypoxemia,nausea,choking,dizziness,injection pain,and vomiting in group R1 were 10.80%,6.80%,2.00%,2.80%,2.80%,2.00%,2.00%,and 0.80%,which were lower than 22.00%,18.00%,8.80%,10.00%,10.00%,14.00%,and 11.20% in group P.There was a statistical difference(P<0.05).Conclusion In elderly patients with painless gastroscopy,the combination of alfentanil and remimazolam tosilate has better sedative and analgesic effects,which can maintain stable vital signs,shorten patients'recovery time,time away from the operating room and examination time,and reduce adverse reactions,thus improving the safety of examination.
作者
李波
LI Bo(Department of Anesthesiology,Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Guangzhou 510800,China)
出处
《中国实用医药》
2025年第2期121-124,共4页
China Practical Medicine
关键词
无痛胃镜
甲苯磺酸瑞马唑仑
阿芬太尼
丙泊酚
老年
镇静镇痛
Painless gastroscopy
Remimazolam tosilate
Alfentanil
Propofol
Old age
Sedation and analgesia
