摘要
目的评估不同剂量甲苯磺酸瑞马唑仑联合丙泊酚在无痛胃镜检查中的应用效果及安全性。方法选取进行无痛胃镜检查的患者228例,随机分为A组、B组和C组,每组76例。A组先缓慢静脉注射甲苯磺酸瑞马唑仑0.15 mg/kg,再静脉注射丙泊酚1 mg/kg进行麻醉;B组先缓慢静脉注射甲苯磺酸瑞马唑仑0.2 mg/kg,再静脉注射丙泊酚1 mg/kg进行麻醉;C组先静脉注射生理盐水0.2 ml/kg,再缓慢静脉注射丙泊酚1.5 mg/kg进行麻醉。对比三组镇静成功率、生命体征变化情况、镇静深度评分及苏醒时间、不良反应发生情况。结果A组镇静成功率为89.47%(68/76),B组为97.37%(74/76),C组为88.16%(67/76),B组的镇静成功率显著高于A组和C组,差异有统计学意义(P<0.05);A组与C组镇静成功率对比,差异无统计学意义(P>0.05)。A组收缩压波动为(10.23±3.48)mm Hg(1 mm Hg=0.133 kPa),舒张压波动为(6.79±2.16)mm Hg,心率波动为(6.37±2.13)次/min,血氧饱和度(SpO_(2))波动为(2.54±0.81)%;B组收缩压波动为(15.84±4.37)mm Hg,舒张压波动为(9.41±3.25)mm Hg,心率波动为(9.28±3.02)次/min,SpO_(2)波动为(4.15±1.29)%;C组收缩压波动为(11.45±3.16)mm Hg,舒张压波动为(7.52±2.34)mm Hg,心率波动为(6.89±2.41)次/min,SpO_(2)波动为(2.67±0.98)%。B组收缩压、舒张压、心率、SpO_(2)波动大于A组和C组,差异有统计学意义(P<0.05)。B组的镇静深度评分(5.34±0.83)分明显高于A组的(4.67±1.01)分和C组的(3.98±1.12)分,且A组高于C组,差异有统计学意义(P<0.05)。B组的苏醒时间(9.45±2.18)min明显长于A组的(6.23±1.36)min和C组的(6.16±1.27)min,差异均具有统计学意义(P<0.05);A组和C组的苏醒时间对比,差异无统计学意义(P>0.05)。B组不良反应发生率17.11%高于A组的3.95%和C组的6.58%,差异有统计学意义(P<0.05);但A组、C组不良反应发生率对比,差异无统计学意义(P>0.05)。结论甲苯磺酸瑞马唑仑复合丙泊酚在无痛胃镜检查中具有较为显著的镇静效果,尤其是高剂量干预组镇静成功率和镇静深度评分显著提高,但伴随较长的苏醒时间以及较高的不良反应发生率,提示其安全性较差。相比之下,低剂量甲苯磺酸瑞马唑仑联合丙泊酚镇静效果适中,镇静成功率和镇静深度评分虽低于高剂量甲苯磺酸瑞马唑仑联合丙泊酚,但安全性更高,尤其在生命体征波动、苏醒时间和不良反应发生率方面表现较好,显示出更好的临床应用前景。
Objective To evaluate the application effect and safety of different doses of remimazolam tosilate combined with propofol in painless gastroscopy.Methods A total of 228 patients underwent painless gastroscopy and were randomly divided into group A,group B and group C,with 76 cases in each group.Group A first received slow intravenous injection of 0.15 mg/kg remimazolam tosilate,followed by intravenous injection of 1 mg/kg propofol for anesthesia;group B first received slow intravenous injection of 0.2 mg/kg remimazolam tosilate,followed by intravenous injection of 1 mg/kg propofol for anesthesia;group C first received intravenous injection of 0.2 ml/kg physiological saline,followed by slow intravenous injection of 1.5 mg/kg propofol for anesthesia.Comparison of the success rate of sedation,changes in vital signs,sedation depth score and recovery time,and incidence of adverse reactions among three three groups.Results The success rate of sedation was 89.47%(68/76)in group A,97.37%(74/76)in group B,and 88.16%(67/76)in group C;the success rate of sedation in group B was significantly higher than that in group A and group C,and the difference was statistically significant(P<0.05),but there was no statistically significant difference in success rate of sedation between group A and group C(P>0.05).In group A,the systolic blood pressure fluctuation was(10.23±3.48)mm Hg(1 mm Hg=0.133 kPa),the diastolic blood pressure fluctuation was(6.79±2.16)mm Hg,the heart rate fluctuation was(6.37±2.13)beats/min,and the blood oxygen saturation(SpO_(2))fluctuation was(2.54±0.81)%;in group B,the systolic blood pressure fluctuation was(15.84±4.37)mm Hg,the diastolic blood pressure fluctuation was(9.41±3.25)mm Hg,the heart rate fluctuation was(9.28±3.02)beats/min,and SpO_(2) fluctuation was(4.15±1.29)%;in group C,the systolic blood pressure fluctuation was(11.45±3.16)mm Hg,the diastolic blood pressure fluctuation was(7.52±2.34)mm Hg,the heart rate fluctuation was(6.89±2.41)beats/min,and SpO_(2) fluctuation was(2.67±0.98)%.The fluctuation of systolic blood pressure,diastolic blood pressure,heart rate and SpO_(2) in group B was higher than those in group A and group C,and the difference was statistically significant(P<0.05).The sedation depth score of group B was(5.34±0.83)points,which was significantly higher than(4.67±1.01)points of group A and(3.98±1.12)points of group C,and group A was higher than group C.The difference was statistically significant(P<0.05).The recovery time of group B was(9.45±2.18)min,which was significantly longer than(6.23±1.36)min of group A and(6.16±1.27)min of group C,and the differences were statistically significant(P<0.05).There was no significant difference in the recovery time between group A and group C(P>0.05).The incidence of adverse reactions in group B was 17.11%,which was higher than 3.95%in group A and 6.58%in group C,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between group A and group C(P>0.05).Conclusion Remimazolam tosilate combined with propofol has a relatively significant sedative effect in painless gastroscopy,especially in the high-dose intervention group,the success rate of sedation and sedation depth score are significantly improved,but it is associated with a longer recovery time and a higher incidence of adverse reactions,suggesting that its safety is poor.In contrast,low-dose remimazolam tosilate combined with propofol has moderate sedation effect,and although the success rate of sedation and sedation depth score are lower than that of high-dose remimazolam tosilate combined with propofol,and it is safer,especially in the aspects of vital signs fluctuation,recovery time and incidence of adverse reactions,showing better clinical application prospects.
作者
胜海峰
孙素花
刘颖
谢庆国
胡振华
SHENG Hai-feng;SUN Su-hua;LIU Ying(Chengwu County People's Hospital of Shandong Province,Heze 274200,China)
出处
《中国实用医药》
2025年第10期21-25,共5页
China Practical Medicine
基金
山东省医学会舒适化医疗-基层优化专项资金项目(项目编号:YXH2022ZX04237)。
