摘要
目的探讨瑞马唑仑联合依托咪酯用于老年患者无痛支气管镜检查的安全性、有效性。方法选取2021年3月至2024年6月陕西省第二人民医院行无痛支气管镜检查的老年患者80例,年龄≥70岁,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,体质量指数(BMI)16.0~30.0 kg/m^(2),采用随机数字表法将患者分为对照组(n=40)和观察组(n=40)。两组均血浆靶控输注瑞芬太尼5 ng/mL,3 min后对照组给予丙泊酚+依托咪酯+米库氯铵,观察组给予瑞马唑仑+依托咪酯+米库氯铵,自主呼吸消失辅助通气5 min后置入喉罩,瑞芬太尼效应室浓度达到5 ng/mL进镜检查。记录麻醉诱导前(T_(0))、麻醉诱导后即刻(T_(1))、进境入声门时(T_(2))、镜检开始5 min时(T_(3))、结束退镜出声门时(T_(4))、拔出喉罩时刻(T_(5))、出气管镜诊疗室前(T_(6))等不同时间节点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))及脑电双频指数(BIS)值等指标。记录停药至呼吸恢复时间、拔管时间、达到离室标准的时间,记录注射痛、低血压、心动过缓等不良反应发生例数,记录追加镇静药物、阿托品、去甲肾上腺素及肾上腺素等的使用情况。结果在T_(1)、T_(2)、T_(3)、T_(4)时观察组的MAP、HR高于对照组(P<0.05),两组患者SpO_(2)、BIS比较差异无统计学意义(P>0.05);两组患者呼吸恢复时间、拔管时间比较差异无统计学意义(P>0.05);两组患者追加依托咪酯的剂量及频率差异无统计学意义(P>0.05);观察组阿托品、去甲肾上腺素及肾上腺素的使用剂量低于对照组,差异有统计学意义(P<0.01)。结论瑞马唑仑联合依托咪酯用于老年患者无痛支气管镜麻醉血流动力学相对稳定,不良反应少,安全性高,可推广。
Objective To explore the safety and efficacy of remimazolam combined with etomidate for elderly patients undergoing painless bronchoscopy.Methods A total of 80 elderly patients,aged≥70 years,of American Society of Anesthesiologists(ASA)physical statusⅡorⅢ,with body mass index(BMI)16.0-30.0 kg/m^(2),who underwent painless bronchoscopy at Shaanxi Second Provincial People’s Hospital from March 2021 to June 2024 were selected and randomly divided into the control group(n=40)and the observation group(n=40)using a random number table method.Both groups received plasma target-controlled infusion of remifentanil at 5 ng/mL.After 3 min,the control group was given propofol+etomidate+mivacurium chloride,and the observation group was given remimazolam+etomidate+mivacurium chloride,and assisted ventilation was performed for 5 min after the disappearance of spontaneous breathing.A laryngeal mask was inserted,and the remifentanil effect chamber reached 5 ng/mL.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2)),and bispectral index(BIS)before anesthesia induction(T_(0)),immediately after anesthesia induction(T_(1)),when entering the glottic region(T_(2)),5 min after initiation of bronchossopy(T_(3)),when the endoscopy was removed out of the glottic region(T_(4)),the moment of removing the laryngeal mask(T_(5)),and before leaving the bronchoscope exam room(T_(6))were recorded.The time from drug withdrawal to respiratory recovery of the patients,the time of extubation,and the time to reach the criteria for leaving the room were recorded.The number of cases of adverse reactions such as injection pain,hypotension,and bradycardia were recorded.The addition of sedative drugs and the use of atropine,norepinephrine and epinephrine were recorded.Results At T_(1),T_(2),T_(3),T_(4)MAP and HR of the observation group were higher than those of the control group(P<0.05),while there was no statistically significant difference in SpO₂and BIS between the two groups(P>0.05);there was no statistically significant difference in the respiratory recovery time and extubation time between the two groups(P>0.05);there was no statistically significant difference in the dosage and frequency of the additional sedative drug etomidate between the two groups(P>0.05);the dosage of atropine,norepinephrine and epinephrine used in the observation group was lower than that in the control group,with statistically significant difference(P<0.01).Conclusion Remimazolam combined with etomidate for elderly patients undergoing painless bronchoscopy has relatively stable hemodynamics,few adverse reactions,high safety,and can be promoted.
作者
薛萌
蔡英敏
XUE Meng;CAI Yingmin(Xi’an Jiaotong University,Xi’an 710000;Department of Anesthesiology,Shaanxi Second Provincial People’s Hospital,Xi’an 710000;Department of Anesthesiology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710000,China)
出处
《麻醉安全与质控》
2025年第5期389-393,共5页
Perioperative Safety and Quality Assurance
