Objective:To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients.Methods:Seventy-two cases of elderly debilitated patients who u...Objective:To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients.Methods:Seventy-two cases of elderly debilitated patients who underwent fiberoptic bronchoscopy in the Department of Respiratory Medicine of a hospital from August 2023 to July 2024 were selected,and were divided into the control group and the observation group using the mean score method,with 36 cases in each group.In both groups,7–10μg/kg alfentanil was injected intravenously after oxygen denitrification,and 1 min later propofol 1.5 mg/kg was given intravenously in the control group and remazolam 0.3 mg/kg was given intravenously in the observation group.Subsequently,mivacurium chloride 0.1mg/kg IV was given to both groups.Propofol 5mg/(kg-h)was given in the control group and remazolam 0.5mg/(kg-h)was given intravenously pumped in the observation group during anesthesia maintenance.Changes in vital signs such as HR,MAP and SpO_(2) and the occurrence of adverse reactions were recorded in the two groups before anesthesia administration(T_(1)),at the moment of placing fiberoptic bronchoscope(T_(2)),at the moment of placing the tracheal tube(T_(3)),and at 1 min after placing the tracheal tube(T4).Results:Compared with T1,patients in the observation group had lower MAP at T_(2),T_(3),T_(4) and lower SpO_(2) at T_(3),T_(4)(P<0.05);in the control group,HR slowed down at T_(2),T_(3),T_(4) and MAP and SpO_(2) decreased at T_(2),T_(3),T_(4)(P<0.05).SpO_(2) at T_(3) and T_(4) was lower in both groups compared with that at T2(P<0.05).SpO_(2) at T_(4) was lower in the control group compared with that at T_(3)(P<0.05).Compared with the control group,patients in the observation group suffered from increased HR and elevated MAP at T_(2),T_(3),and T_(4),and increased SpO_(2) at T_(3) and T4(P<0.05).The incidence of intraoperative hypotension and bradycardia in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of intraoperative choking and coughing,postoperative hypoxemia,nausea and vomiting,and dizziness were found in the patients of both groups,drowsiness and other adverse reactions incidence rate comparison,the difference are not statistically significant(P>0.05).Conclusion:Remazolam and alfentanil are used in fiberoptic bronchoscopy for elderly debilitated patients with remarkable effect,which can effectively improve the vital signs of patients,reduce the risk of intraoperative hypotension,bradycardia,and other adverse reactions,and have high anesthetic effectiveness and safety.展开更多
This study explores a novel noninvasive method for monitoring blood alfentanil concentrations using a dog model. Alfentanil which 'back', permeated across the oral mucosa from the systemic circulation was coll...This study explores a novel noninvasive method for monitoring blood alfentanil concentrations using a dog model. Alfentanil which 'back', permeated across the oral mucosa from the systemic circulation was collected from the oral mucosal surface and quantitated. The levels of the 'back' permeated alfentanil were found to closely reflect real time serum alfentanil concentrations. With further work, this finding may lead to a novel noninvasive method for monitoring real time serum alfentanil concentrations in its clinical applications.展开更多
Background and aim: Instability in the hemodynamic symptoms has been common at the time of extubation in patients and the cause to create the side effects. The aim of this research was to study the effect of injection...Background and aim: Instability in the hemodynamic symptoms has been common at the time of extubation in patients and the cause to create the side effects. The aim of this research was to study the effect of injection of Alfentanil, Lidocaine and their composition in reduction of side effects arising from extubation. Materials and methods: 172 patients (20 - 40 years old) that referred to Shahid Rajaee Hospital in 2014 and had been under the orthopedic surgery, were divided randomly and by using colored cards into four equal groups (43 patients in each group). Alfentanil (5 microgram/kilogram) was injected to the first group. The second group received Lidocaine (1 milligram/ kilogram). The composition of these two drugs was injected to the third group and the normal equal volume of Saline was injected to the fourth group which was the control group. The means of systolic and diastolic blood pressure, average arterial pressure and the number of heartbeat at the time of extubation were measured and registered 1, 5, 10, 15 and 20 minutes after extubation. Also, the amount of situation of bucking after extubation was registered in the groups. Results: The demographic results were similar in all groups. The mean of systolic blood pressure and number of heartbeats in the group of Alfentanil and composition of Alfentanil-Lidocaine had significant reduction (p 0.05). The situation of bucking in three treatment groups had significant reduction in comparison with control group. Conclusion: Alfentanil and composition of it with Lidocaine both had caused reducing the systolic blood pressure and heartbeats.展开更多
Background: Patient-controlled sedation (PCS) is increasingly used for moderate sedation. Detailed understanding is essential for maintaining safety and giving the most benefit. We wanted to explore the associations b...Background: Patient-controlled sedation (PCS) is increasingly used for moderate sedation. Detailed understanding is essential for maintaining safety and giving the most benefit. We wanted to explore the associations between patients’ characteristics, perioperative pain and anxiety, the procedure, and the calculated concentrations at the effect site (Ce) of propofol. We also wanted to analyse the pharmacokinetic profiles of propofol and alfentanil during PCS, and their association with respiratory complications. Methods: 155 patients were double-blinded and randomised to have propofol or propofol and alfentanil for PCS during gynaecological surgery. Pharmacokinetic simulation of Ce and multiple regressions aided the search for correlations between explanatory variables and concentrations of drugs. Results: In group propofol, treatment for incontinence, anterior repair, and the patient’s weight correlated the best (B-coef = 0.20, 0.20 and 0.01;r = 0.69;r² = 0.48). When alfentanil was added, alfentanil and the patient’s weight were associated with Ce of propofol (B-coef = ǂ.40 and 0.01;r = 0.70;r² = 0.43). Logistic regression indicated that age and Ce of drugs were related to ten cases of respiratory complications. Conclusions: Patients’ weights and the type of surgery performed were associated with the Ce of propofol;this knowledge could be used for refinement of the doses given during PCS. Because the pharmacokinetic profiles of propofol and alfentanil are different, the alfentanil effect becomes predominant during the time course of sedation. In order to reduce the risk of early and late respiratory depression, alfentanil should not be added to propofol in the same syringe.展开更多
Objective:To observe the effects of remimazolam benzenesulfonate combined with alfentanil during painless gastroenteroscopy in elderly patients.Methods:This study analyzes patients aged 60–85 years old undergoing pai...Objective:To observe the effects of remimazolam benzenesulfonate combined with alfentanil during painless gastroenteroscopy in elderly patients.Methods:This study analyzes patients aged 60–85 years old undergoing painless gastroenteroscopy.A total of 140 patients,examined between February 2023 and February 2024,voluntarily participated and were randomly divided into an experimental group and a control group.The control group received alfentanil combined with propofol for anesthesia,while the experimental group received alfentanil combined with remimazolam benzenesulfonate.The relevant indices of both groups were separately analyzed.Results:Patients in the experimental group had a shorter awakening time,a faster discharge rate(P<0.05),and a shorter examination duration;however,the difference in examination time between the two groups was not statistically significant(P>0.05).Before anesthesia,there was no significant difference in the basic information and vital signs of the two groups(P>0.05).Two minutes after anesthesia,both groups showed a decline in vital signs,but the vital signs of the experimental group remained more stable after the procedure,with the group’s indices showing improvement over the control group(P<0.05).Additionally,the incidence of adverse reactions in the experimental group was lower than in the control group(P<0.05).Conclusion:In painless gastroenteroscopy for elderly patients,anesthesia using a combination of remimazolam benzenesulfonate and alfentanil improves anesthesia effectiveness,hastens patient recovery,enhances the stability of vital signs,and effectively controls adverse reactions,thereby improving patient comfort.展开更多
Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to on...Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to one of three groups,Group A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(in Group B)or 30 μg/kg alfentanil(in Group C)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0 1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation. Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0 05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,147±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0 01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0 05).NE in Groups A and B increased significantly to 5 75±3 51 and 6 75±3 30 nmol/L 3 min after intubation(P<0 01).In Group C,3 min after intubation NE was not significantly different from the baseline but E decreased significantly(P<0 01). Conclusion.2 mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.展开更多
目的:瑞马唑仑复合阿芬太尼在无痛胃镜检查中可提供可靠的麻醉效果,但肥胖对大多数麻醉药物的药代动力学有显著影响,如果常规按照体重给药可导致肥胖患者的不良事件增多。目前临床上尚缺乏瑞马唑仑用于肥胖患者的药效学数据。本研究旨...目的:瑞马唑仑复合阿芬太尼在无痛胃镜检查中可提供可靠的麻醉效果,但肥胖对大多数麻醉药物的药代动力学有显著影响,如果常规按照体重给药可导致肥胖患者的不良事件增多。目前临床上尚缺乏瑞马唑仑用于肥胖患者的药效学数据。本研究旨在探究抛偏倚硬币设计(biased coin design,BCD)测定复合阿芬太尼时瑞马唑仑用于肥胖患者无痛胃镜检查的95%有效剂量(effective dose for 95%patients,ED_(95))。方法:选取择期行无痛胃镜检查(使用瑞马唑仑复合阿芬太尼进行麻醉)的患者80例,年龄18~65岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ或Ⅱ级。根据患者的体重指数(body mass index,BMI)将其分为对照组和肥胖组。采用BCD计算无痛胃镜检查中瑞马唑仑的ED_(95)。诱导麻醉前给予患者流量为4 L/min的充分预吸氧,随后静脉缓慢注射阿芬太尼(剂量为5μg/kg)和瑞马唑仑,待患者睫毛反射消失、下颌松弛、改良警觉/镇静评分(Modified Observer’s Assessment of Alertness/Sedation Scale,MOAA/S)≤1后进行胃镜检查。瑞马唑仑的初始剂量设定为0.1 mg/kg,剂量梯度为0.02 mg/kg。若注射瑞马唑仑3 min后,MOAA/S>1或进镜时患者出现体动、呛咳、吞咽等影响操作的反应则认为是阳性反应(无效),否则为阴性反应(有效)。若发生阳性反应,下一例患者的剂量升高1个梯度;若发生阴性反应,下一例患者按照0.95的概率接受相同剂量,0.05的概率接受降低1个梯度的剂量,直至每组各完成40例。结果:对照组和肥胖组患者的体重、身高和BMI之间的差异均有统计学意义(均P<0.05);对照组和肥胖组无痛胃镜检查中复合阿芬太尼时瑞马唑仑的ED_(95)及其95%置信区间(confidence interval,CI)分别为0.157(0.142,0.168)mg/kg和0.137(0.129,0.144)mg/kg,且2组瑞马唑仑ED_(95)的83%CI没有重叠(P<0.05);对照组发生低血压1例、呃逆2例,而肥胖组发生低血压、呼吸抑制(脉搏血氧饱和度<90%)、呃逆各1例;2组均未见其他不良反应。结论:对照组和肥胖组无痛胃镜检查中复合阿芬太尼时瑞马唑仑的ED_(95)分别为0.157 mg/kg和0.137 mg/kg,即肥胖患者需要的瑞马唑仑剂量明显低于正常患者,且瑞马唑仑并未增加肥胖患者呼吸抑制的风险。展开更多
目的观察和比较阿芬太尼、布托啡诺以及舒芬太尼复合丙泊酚用于宫腔镜手术的镇痛、镇静效果及对患者术后恢复的影响。方法选择择期行无痛宫腔镜手术女性患者150例,年龄18~55岁,BMI 18.5~28.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将...目的观察和比较阿芬太尼、布托啡诺以及舒芬太尼复合丙泊酚用于宫腔镜手术的镇痛、镇静效果及对患者术后恢复的影响。方法选择择期行无痛宫腔镜手术女性患者150例,年龄18~55岁,BMI 18.5~28.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组:阿芬太尼10μg/kg(A组)、布托啡诺20μg/kg(B组)和舒芬太尼0.1μg/kg(S组),每组50例。给予镇痛药物后,每组静脉注射丙泊酚2 mg/kg。待患者睫毛反射消失后开始宫腔镜操作。记录术中低血压、心动过缓、呼吸抑制和呛咳及术后恶心呕吐、头晕、头痛等发生情况。记录入室时、扩张宫颈时、置入宫腔镜时、手术结束时的HR、MAP、SpO_(2)。记录术中丙泊酚的诱导剂量、单位时间追加剂量和总量、术后睁眼时间、清醒时间、术后15 min、2和6 h的VAS疼痛评分。结果与入室时比较,A、B组扩张宫颈时、置入宫腔镜时、手术结束时HR明显减慢、MAP、SpO_(2)均明显下降,S组扩张宫颈时、置入宫腔镜时、手术结束时HR明显减慢、MAP均明显下降,置入宫腔镜时以及手术结束时SpO_(2)明显下降(P<0.05)。与A组比较,B组和S组的术后恶心呕吐发生率明显升高,B组术后头晕和术后头痛发生率和术后15 min VAS疼痛评分明显升高,S组术后2和6 h VAS评分明显升高(P<0.05)。与B组比较,S组的术后恶心呕吐和术后头晕的发生率明显降低,术后6 h VAS疼痛评分明显升高,A组和S组睁眼时间和清醒时间明显缩短(P<0.05)。结论与布托啡诺和舒芬太尼复合丙泊酚比较,阿芬太尼复合丙泊酚用于宫腔镜手术对术中循环影响较小,且术后患者恢复清醒时间短,术后恶心呕吐等不良反应发生率更低。展开更多
文摘Objective:To analyze the application value of remazolam compound alfentanil anesthesia regimen in fiberoptic bronchoscopy in elderly debilitated patients.Methods:Seventy-two cases of elderly debilitated patients who underwent fiberoptic bronchoscopy in the Department of Respiratory Medicine of a hospital from August 2023 to July 2024 were selected,and were divided into the control group and the observation group using the mean score method,with 36 cases in each group.In both groups,7–10μg/kg alfentanil was injected intravenously after oxygen denitrification,and 1 min later propofol 1.5 mg/kg was given intravenously in the control group and remazolam 0.3 mg/kg was given intravenously in the observation group.Subsequently,mivacurium chloride 0.1mg/kg IV was given to both groups.Propofol 5mg/(kg-h)was given in the control group and remazolam 0.5mg/(kg-h)was given intravenously pumped in the observation group during anesthesia maintenance.Changes in vital signs such as HR,MAP and SpO_(2) and the occurrence of adverse reactions were recorded in the two groups before anesthesia administration(T_(1)),at the moment of placing fiberoptic bronchoscope(T_(2)),at the moment of placing the tracheal tube(T_(3)),and at 1 min after placing the tracheal tube(T4).Results:Compared with T1,patients in the observation group had lower MAP at T_(2),T_(3),T_(4) and lower SpO_(2) at T_(3),T_(4)(P<0.05);in the control group,HR slowed down at T_(2),T_(3),T_(4) and MAP and SpO_(2) decreased at T_(2),T_(3),T_(4)(P<0.05).SpO_(2) at T_(3) and T_(4) was lower in both groups compared with that at T2(P<0.05).SpO_(2) at T_(4) was lower in the control group compared with that at T_(3)(P<0.05).Compared with the control group,patients in the observation group suffered from increased HR and elevated MAP at T_(2),T_(3),and T_(4),and increased SpO_(2) at T_(3) and T4(P<0.05).The incidence of intraoperative hypotension and bradycardia in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of intraoperative choking and coughing,postoperative hypoxemia,nausea and vomiting,and dizziness were found in the patients of both groups,drowsiness and other adverse reactions incidence rate comparison,the difference are not statistically significant(P>0.05).Conclusion:Remazolam and alfentanil are used in fiberoptic bronchoscopy for elderly debilitated patients with remarkable effect,which can effectively improve the vital signs of patients,reduce the risk of intraoperative hypotension,bradycardia,and other adverse reactions,and have high anesthetic effectiveness and safety.
文摘This study explores a novel noninvasive method for monitoring blood alfentanil concentrations using a dog model. Alfentanil which 'back', permeated across the oral mucosa from the systemic circulation was collected from the oral mucosal surface and quantitated. The levels of the 'back' permeated alfentanil were found to closely reflect real time serum alfentanil concentrations. With further work, this finding may lead to a novel noninvasive method for monitoring real time serum alfentanil concentrations in its clinical applications.
文摘Background and aim: Instability in the hemodynamic symptoms has been common at the time of extubation in patients and the cause to create the side effects. The aim of this research was to study the effect of injection of Alfentanil, Lidocaine and their composition in reduction of side effects arising from extubation. Materials and methods: 172 patients (20 - 40 years old) that referred to Shahid Rajaee Hospital in 2014 and had been under the orthopedic surgery, were divided randomly and by using colored cards into four equal groups (43 patients in each group). Alfentanil (5 microgram/kilogram) was injected to the first group. The second group received Lidocaine (1 milligram/ kilogram). The composition of these two drugs was injected to the third group and the normal equal volume of Saline was injected to the fourth group which was the control group. The means of systolic and diastolic blood pressure, average arterial pressure and the number of heartbeat at the time of extubation were measured and registered 1, 5, 10, 15 and 20 minutes after extubation. Also, the amount of situation of bucking after extubation was registered in the groups. Results: The demographic results were similar in all groups. The mean of systolic blood pressure and number of heartbeats in the group of Alfentanil and composition of Alfentanil-Lidocaine had significant reduction (p 0.05). The situation of bucking in three treatment groups had significant reduction in comparison with control group. Conclusion: Alfentanil and composition of it with Lidocaine both had caused reducing the systolic blood pressure and heartbeats.
基金the Department of Anaesthesiology and Intensive Care, Linkoping UniversityHospital
文摘Background: Patient-controlled sedation (PCS) is increasingly used for moderate sedation. Detailed understanding is essential for maintaining safety and giving the most benefit. We wanted to explore the associations between patients’ characteristics, perioperative pain and anxiety, the procedure, and the calculated concentrations at the effect site (Ce) of propofol. We also wanted to analyse the pharmacokinetic profiles of propofol and alfentanil during PCS, and their association with respiratory complications. Methods: 155 patients were double-blinded and randomised to have propofol or propofol and alfentanil for PCS during gynaecological surgery. Pharmacokinetic simulation of Ce and multiple regressions aided the search for correlations between explanatory variables and concentrations of drugs. Results: In group propofol, treatment for incontinence, anterior repair, and the patient’s weight correlated the best (B-coef = 0.20, 0.20 and 0.01;r = 0.69;r² = 0.48). When alfentanil was added, alfentanil and the patient’s weight were associated with Ce of propofol (B-coef = ǂ.40 and 0.01;r = 0.70;r² = 0.43). Logistic regression indicated that age and Ce of drugs were related to ten cases of respiratory complications. Conclusions: Patients’ weights and the type of surgery performed were associated with the Ce of propofol;this knowledge could be used for refinement of the doses given during PCS. Because the pharmacokinetic profiles of propofol and alfentanil are different, the alfentanil effect becomes predominant during the time course of sedation. In order to reduce the risk of early and late respiratory depression, alfentanil should not be added to propofol in the same syringe.
文摘Objective:To observe the effects of remimazolam benzenesulfonate combined with alfentanil during painless gastroenteroscopy in elderly patients.Methods:This study analyzes patients aged 60–85 years old undergoing painless gastroenteroscopy.A total of 140 patients,examined between February 2023 and February 2024,voluntarily participated and were randomly divided into an experimental group and a control group.The control group received alfentanil combined with propofol for anesthesia,while the experimental group received alfentanil combined with remimazolam benzenesulfonate.The relevant indices of both groups were separately analyzed.Results:Patients in the experimental group had a shorter awakening time,a faster discharge rate(P<0.05),and a shorter examination duration;however,the difference in examination time between the two groups was not statistically significant(P>0.05).Before anesthesia,there was no significant difference in the basic information and vital signs of the two groups(P>0.05).Two minutes after anesthesia,both groups showed a decline in vital signs,but the vital signs of the experimental group remained more stable after the procedure,with the group’s indices showing improvement over the control group(P<0.05).Additionally,the incidence of adverse reactions in the experimental group was lower than in the control group(P<0.05).Conclusion:In painless gastroenteroscopy for elderly patients,anesthesia using a combination of remimazolam benzenesulfonate and alfentanil improves anesthesia effectiveness,hastens patient recovery,enhances the stability of vital signs,and effectively controls adverse reactions,thereby improving patient comfort.
文摘Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to one of three groups,Group A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(in Group B)or 30 μg/kg alfentanil(in Group C)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0 1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation. Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0 05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,147±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0 01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0 05).NE in Groups A and B increased significantly to 5 75±3 51 and 6 75±3 30 nmol/L 3 min after intubation(P<0 01).In Group C,3 min after intubation NE was not significantly different from the baseline but E decreased significantly(P<0 01). Conclusion.2 mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.
文摘目的:瑞马唑仑复合阿芬太尼在无痛胃镜检查中可提供可靠的麻醉效果,但肥胖对大多数麻醉药物的药代动力学有显著影响,如果常规按照体重给药可导致肥胖患者的不良事件增多。目前临床上尚缺乏瑞马唑仑用于肥胖患者的药效学数据。本研究旨在探究抛偏倚硬币设计(biased coin design,BCD)测定复合阿芬太尼时瑞马唑仑用于肥胖患者无痛胃镜检查的95%有效剂量(effective dose for 95%patients,ED_(95))。方法:选取择期行无痛胃镜检查(使用瑞马唑仑复合阿芬太尼进行麻醉)的患者80例,年龄18~65岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ或Ⅱ级。根据患者的体重指数(body mass index,BMI)将其分为对照组和肥胖组。采用BCD计算无痛胃镜检查中瑞马唑仑的ED_(95)。诱导麻醉前给予患者流量为4 L/min的充分预吸氧,随后静脉缓慢注射阿芬太尼(剂量为5μg/kg)和瑞马唑仑,待患者睫毛反射消失、下颌松弛、改良警觉/镇静评分(Modified Observer’s Assessment of Alertness/Sedation Scale,MOAA/S)≤1后进行胃镜检查。瑞马唑仑的初始剂量设定为0.1 mg/kg,剂量梯度为0.02 mg/kg。若注射瑞马唑仑3 min后,MOAA/S>1或进镜时患者出现体动、呛咳、吞咽等影响操作的反应则认为是阳性反应(无效),否则为阴性反应(有效)。若发生阳性反应,下一例患者的剂量升高1个梯度;若发生阴性反应,下一例患者按照0.95的概率接受相同剂量,0.05的概率接受降低1个梯度的剂量,直至每组各完成40例。结果:对照组和肥胖组患者的体重、身高和BMI之间的差异均有统计学意义(均P<0.05);对照组和肥胖组无痛胃镜检查中复合阿芬太尼时瑞马唑仑的ED_(95)及其95%置信区间(confidence interval,CI)分别为0.157(0.142,0.168)mg/kg和0.137(0.129,0.144)mg/kg,且2组瑞马唑仑ED_(95)的83%CI没有重叠(P<0.05);对照组发生低血压1例、呃逆2例,而肥胖组发生低血压、呼吸抑制(脉搏血氧饱和度<90%)、呃逆各1例;2组均未见其他不良反应。结论:对照组和肥胖组无痛胃镜检查中复合阿芬太尼时瑞马唑仑的ED_(95)分别为0.157 mg/kg和0.137 mg/kg,即肥胖患者需要的瑞马唑仑剂量明显低于正常患者,且瑞马唑仑并未增加肥胖患者呼吸抑制的风险。
文摘目的观察和比较阿芬太尼、布托啡诺以及舒芬太尼复合丙泊酚用于宫腔镜手术的镇痛、镇静效果及对患者术后恢复的影响。方法选择择期行无痛宫腔镜手术女性患者150例,年龄18~55岁,BMI 18.5~28.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组:阿芬太尼10μg/kg(A组)、布托啡诺20μg/kg(B组)和舒芬太尼0.1μg/kg(S组),每组50例。给予镇痛药物后,每组静脉注射丙泊酚2 mg/kg。待患者睫毛反射消失后开始宫腔镜操作。记录术中低血压、心动过缓、呼吸抑制和呛咳及术后恶心呕吐、头晕、头痛等发生情况。记录入室时、扩张宫颈时、置入宫腔镜时、手术结束时的HR、MAP、SpO_(2)。记录术中丙泊酚的诱导剂量、单位时间追加剂量和总量、术后睁眼时间、清醒时间、术后15 min、2和6 h的VAS疼痛评分。结果与入室时比较,A、B组扩张宫颈时、置入宫腔镜时、手术结束时HR明显减慢、MAP、SpO_(2)均明显下降,S组扩张宫颈时、置入宫腔镜时、手术结束时HR明显减慢、MAP均明显下降,置入宫腔镜时以及手术结束时SpO_(2)明显下降(P<0.05)。与A组比较,B组和S组的术后恶心呕吐发生率明显升高,B组术后头晕和术后头痛发生率和术后15 min VAS疼痛评分明显升高,S组术后2和6 h VAS评分明显升高(P<0.05)。与B组比较,S组的术后恶心呕吐和术后头晕的发生率明显降低,术后6 h VAS疼痛评分明显升高,A组和S组睁眼时间和清醒时间明显缩短(P<0.05)。结论与布托啡诺和舒芬太尼复合丙泊酚比较,阿芬太尼复合丙泊酚用于宫腔镜手术对术中循环影响较小,且术后患者恢复清醒时间短,术后恶心呕吐等不良反应发生率更低。
