摘要
目的探讨不同剂量瑞马唑仑联合阿芬太尼对高龄患者经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)血流动力学的影响。方法选取2024年8—12月北部战区总医院择期行监护麻醉下ERCP的高龄患者。根据诱导期瑞马唑仑的不同使用剂量,将患者分为低剂量组(R1组,0.15 mg/kg)、中剂量组(R2组,0.20 mg/kg)和高剂量组(R3组,0.25 mg/kg)。麻醉诱导期静脉注射阿芬太尼5μg/kg和不同剂量瑞马唑仑,麻醉维持期均持续泵注瑞马唑仑1 mg/(kg·h)和阿芬太尼0.5μg/(kg·min)。观察和比较3组患者诱导期低血压发生率,不良事件发生率,诱导期体动率、补救镇静率、意识消失时间、手术时间和苏醒时间,不同时点[诱导前(T0)、诱导后1 min(T1)、诱导后2 min(T2)、诱导后3 min(T3)、诱导后4 min(T4)、诱导后5 min(T5)]的MAP、HR、SpO_(2)、脑电双频指数(bispectral index,BIS)。结果共纳入199例患者,其中男94例、女105例,年龄75~87岁;平均(81.1±3.1)岁。与R1组相比,R3组诱导期低血压发生率较高(29.9%比6.1%)、低氧血症发生率较高(17.9%比1.5%),差异均有统计学意义(P<0.05)。与R1组相比,R2组和R3组的体动率较低(9.1%和0%比22.7%)、意识消失时间较短[(75.8±3.0)s和(75.0±2.8)s比(77.1±3.0)s]、补救镇静率较低(9.1%和0%比22.7%),差异均有统计学意义(P<0.05)。3组手术时间和苏醒时间的比较,差异均无统计学意义(P>0.05)。T1~T4时点,与R1组相比,R3组的MAP、HR明显降低;T1~T2时点,与R1组相比,R3组的SpO_(2)明显降低,差异均有统计意义(P<0.05)。结论瑞马唑仑0.20 mg/kg联合阿芬太尼5μg/kg用于高龄患者经ERCP的麻醉诱导安全有效,可降低诱导期低血压和低氧血症发生率,血流动力学稳定。
Objective To explore the effect of different doses of remimazolam combined with alfentanil on hemodynamics in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods Patients undergoing ERCP under monitored anesthesia care in General Hospital of Northern Theater Command from August to December 2024 were selected.Patients were divided into low-dose group(R1 group,0.15 mg/kg),middle-dose group(R2 group,0.20 mg/kg)and high-dose group(R3 group,0.25 mg/kg)according to the different doses of remimazolam during induction.During the induction period of anesthesia,alfentanil at a dose of 5μg/kg and different doses of remazolam were injected intravenously.During the maintenance period of anesthesia,remimazolam at 1 mg/(kg·h)and alfentanil at 0.5μg/(kg·min)were continuously pumped.The incidence of hypotension and adverse events,the rate of body movement and salvage sedation,the time of consciousness disappearance,the duration of operation and the time of awakening,and MAP,HR,SpO_(2) and bispectral index(BIS)at different time points included before induction(T0),1 min after induction(T1),2 min after induction(T2),3 min after induction(T3),4 min after induction(T4)and 5 min after induction(T5)of patients in the three groups were observed and compared in three groups.Results A total of 199 patients were included,including 94 males and 105 females,aged from 75~87 years,with an average age of(81.1±3.1)years.Compared with R1 group,R3 group had higher incidence of hypotension(29.9%vs.6.1%)and hypoxemia(17.9%vs.1.5%)during the induction period,and the differences were statistically significant(P<0.05).Compared with R1 group,R2 group and R3 group had lower body movement rate(9.1%and 0%vs.22.7%),shorter time of consciousness disappearance[(75.8±3.0)s and(75.0±2.8)s vs.(77.1±3.0)s],and lower salvage sedation rate(9.1% and 0%vs.22.7%),and the differences were statistically significant(P<0.05).There were no significant differences in operation time and recovery time among the three groups(P>0.05).From T1 to T4,compared with R1 group,MAP and HR in R3 group were significantly lower,while from T1 to T2,compared with R1 group,the SpO_(2) in R3 group decreased significantly,and the differences were statistically significant(P<0.05).Conclusions The combination of remimazolam 0.20 mg/kg and alfentanil 5μg/kg for anesthesia induction in elderly patients undergoing ERCP is safe and effective.It reduces the incidence of hypotension and hypoxemia during induction of anesthesia,and the hemodynamics is stable.
作者
徐嘉营
丁国鹏
崔波
许兆柱
宋丹丹
Xu Jiaying;Ding Guopeng;Cui Bo;Xu Zhaozhu;Song Dandan(Department of Anesthesiology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《北京医学》
2025年第7期588-594,共7页
Beijing Medical Journal
基金
辽宁省民生科技计划(2021JH2/10300011)。
关键词
瑞马唑仑
阿芬太尼
内镜逆行胰胆管造影术
监护麻醉
高龄
remimazolam
alfentanil
endoscopic retrograde cholangiopancreatography(ERCP)
monitored anesthesia care
elderly
