目的 探索瑞马唑仑对老年衰弱患者无痛胃镜检查术的镇静效果。方法 选择2023年5-7月于山西医科大学第二医院门诊内镜中心拟行择期无痛胃镜检查的老年衰弱患者360例,年龄65～80岁,ASA分级Ⅱ或Ⅲ级,BMI 18～30 kg/m2,临床衰弱量表(CFS)评分≥5分,记录术前开放静脉通路时(T0)及术中胃镜通过咽喉部时(T1)抽血检测血清中去甲肾上腺素(NA)、皮质醇(Cor)、Apelin-13。采用随机数字表法分为四组(n=90):R1组、R2组和R3组瑞马唑仑分别为0.1、0.2、0.3 mg/kg,P组为丙泊酚1.5 mg/kg。待患者 MOAA/S评分≤3分及睫毛反射消失后手术开始。记录首次镇静成功率、胃镜检查时间、检查结束后苏醒时间及PACU停留时间,记录外周血指标变化情况及不良反应发生率,随访内镜医师及患者满意度。结果 与P组相比,R1组首次镇静成功率(63.3% vs. 96.7%)显著降低,检查时间[(7.23±1.81)min vs. (5.78±1.83)min]显著延长,T1时外周血中NA、Cor[(4.72±0.56) ng/ml vs. (3.98±0.52) ng/ml],[(143.75±10.47) nmol/L vs. (126.61±9.54) nmol/L]显著升高, Apelin-13[(2.16±0.49) ng/ml vs. (2.81±0.58) ng/ml]显著降低,呛咳、体动发生率(40.0% vs. 17.7%,31.1% vs. 13.3%)显著增高(P<0.05);R2组患者术中检查平稳,低血压,低血氧饱和度发生率明显降低(P＜0.05);R3组患者苏醒时间[(12.82±2.33)min]及PACU停留时间[(32.5±5.5)min]明显延长(P＜0.05)。与R1组相比,R2组首次镇静成功率 (94.4%)明显升高,苏醒时间[(6.59±2.02) min]及PACU停留时间[(23.8±5.1)min]明显缩短,呛咳和体动发生率(14.4%,8.9%)显著降低( P＜0.05)。与R2组比较,R3组苏醒时间及PACU停留时间显著延长(P＜0.05)。结论 瑞马唑仑镇静效果好,恢复质量优,可安全有效应用于老年衰弱患者胃镜检查,且0.2 mg/kg剂量能够使老年衰弱患者检查过程更加平稳,不良反应减少。
Abstract
Objective To explore the sedative effect of remazolam on frail elderly patients undergoing painless gastroscopy. Methods A total of 360 frail elderly patients aged 65-80 years old and with the ASA classification of Ⅱ or Ⅲ, the BMI of 18 to 30 kg/m2, and CFS score ≥ 5 were selected to undergo elective painless gastroscopy in the outpatient endoscopy center of the Second Hospital of Shanxi Medical University from May to July 2023. Serum Norepinephrine(NA), cortisol (Cor), and Apelin-13 were measured by blood samples during preoperative opening of venous access (T0) and intraoperative gastroscopy through throat (T1), respectively. The patients were divided into four groups (n=90) using a randomized numerical table: 0.1, 0.2, 0.3 mg/kg of remazolam in groups R1, R2, and R3, respectively, and 1.5 mg/kg of propofol in group P. Surgery was initiated when the patients' MOAA/S scores were ≤3 and the eyelash reflex disappeared. The success rate of the first sedation, the time of gastroscopy, the time of awakening after the examination and the duration of stay in PACU and the changes of peripheral blood indexes and the incidence of adverse reactions were recorded, and the satisfaction of endoscopists and patients were followed up. Results Compared with P group, the success rate of first sedation (63.3% vs. 96.7%) was significantly lower and the examination time [(7.23±1.81) min vs. (5.78±1.83) min] was significantly longer in R1 group. In addition, NA [(4.72±0.56)ng/ml vs. (3.98±0.52) ng/ml] and Cor [(143.75±10.47) nmol/L vs. (126.61±9.54) nmol/L] in peripheral blood at T1 were significantly elevated, and the incidence of choking and somatic movement (40.0% vs. 17.7%, 31.1% vs. 13.3%) were significantly higher (P<0.05); whereas, the peripheral blood of Apelin-13 [(2.16±0.49) ng/ml vs. (2.81±0.58) ng/ml] was significantly lower. Intraoperative examination of patients in R2 group was smooth, the incidence of hypotension and low oxygen saturation was significantly lower (P<0.05); In group R3, the awakening time [(12.82±2.33)min] and PACU stay time [(32.5±5.5)min] were significantly longer (P<0.05). Compared with group R1, group R2 had a significantly higher rate of successful first sedation (94.4%), a significantly shorter awakening time [(6.59±2.02) min] and PACU stay [(23.8±5.1) min], and a significantly lower incidence of choking and movement (14.4%, 8.9%) (P<0.05).Compared with R2 group, the awakening time and PACU stay in the R3 group was statistically prolonged (P<0.05). Conclusions Remazolam has good sedative effect and excellent recovery quality, and can be safely and effectively used in gastroscopy in elderly frail patients. The remazolam dose of 0.2 mg/kg can make the examination process of elderly frail patients smoother and reduce the adverse reactions.
关键词
瑞马唑仑 /
丙泊酚 /
衰弱 /
无痛胃镜
Key words
remazolam /
propofol /
frail /
painless gastroscopy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Walston J, Hadley E C, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults [J]. J Am Geriatr Soc, 2006, 54(6): 991-1001.
[2] 黄子誉, 赵 红, 冯 艺. 衰弱对老年患者外科手术结局影响的研究进展 [J]. 临床麻醉学杂志, 2022,38(1): 86-91.
[3] Lin C, Darling C, Tsui B C H. Practical regional anesthesia guide for elderly patients [J]. Drugs Aging, 2019, 36(3): 213-234.
[4] 彭 蕊, 王 倩, 杨天爽,等. 不同剂量瑞马唑仑复合舒芬太尼在无痛胃镜检查术中的比较 [J]. 临床麻醉学杂志, 2023,39(4): 389-392.
[5] Chen S H, Yuan T M, Zhang J, et al. Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non-inferiority, phase III trial [J]. J Gastroen Hepatol, 2021,36(2): 474-481.
[6] 余婉秋, 李禹琼, 朱圣姬, 等. 苯磺酸瑞马唑仑与丙泊酚用于无痛结肠镜检查的有效性及安全性的随机、单盲、平行对照研究 [J]. 贵州医药, 2020,44(6): 846-849, 1009.
[7] Cullinan S, O'Mahony D, O'Sullivan D, et al. Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients [J]. Age Ageing, 2016,45(1): 115-120.
[8] Liu W, Yu W, Yu H, et al. Comparison of clinical efficacy and safety between dexmedetomidine and propofol among patients undergoing gastrointestinal endoscopy: a meta-analysis [J]. J Int Med Res, 2021, 49(7):300.
[9] 史成梅, 周 阳, 杨 宁, 等. 丙泊酚用于无痛胃肠镜检查对患者术后精神活动的影响 [J]. 北京大学学报(医学版), 2023,55(2): 324-327.
[10] 纪洪波, 陈 静, 王国林. 在BIS目标导向镇静下瑞马唑仑用于蛛网膜下腔阻滞患者的镇静效果 [J]. 江苏医药, 2022,48(5): 466-469, 473.
[11] Pastis N J, Yarmus L B, Schippers F, et al. Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy [J]. Elsevier, 2019, 155(1): 137-146.
[12] Masui K. Remimazolam besilate, a benzodiazepine, has been approved for general anesthesia!! [J]. J Anesth, 2020, 34(4): 479-482.
[13] 肖兴鹏, 郭 明, 马 岚, 等. 瑞马唑仑-丙泊酚-舒芬太尼用于无痛胃镜检查术患者麻醉的效果 [J]. 中华麻醉学杂志, 2021,41(2): 3.
[14] Kops M S, Pesic M, Petersen K U, et al. Impact of concurrent remifentanil on the sedative effects of remimazolam, midazolam and propofol in cynomolgus monkeys [J]. Eur J Pharmacol, 2021, 34(6):890.
[15] 魏 来, 李洁琼, 洪谭浩, 等. 不同剂量瑞马唑仑用于宫腔镜手术的安全性和有效性 [J]. 临床麻醉学杂志, 2022,38(4): 346-350.
[16] Leung M F, Wang J. Minimax and biobjective portfolio selection based on collaborative neurodynamic optimization [J]. IEEE Trans Neural Netw Learn Syst, 2021,32(7): 2825-2836.
[17] Wang M R, Deng L, Liu G C, et al. Porous organic polymer-derived nanopalladium catalysts for chemoselective synthesis of antitumor benzofuro 2,3-b pyrazine from 2-bromophenol and isonitriles [J]. Org Lett, 2019,21(13): 4929-4932.
[18] Chen L, Huang Y, Yu X, et al. Corynoxine protects dopaminergic neurons through inducing autophagy and diminishing neuroinflammation in rotenone-induced animal models of Parkinson's disease [J]. Front Pharmacol, 2021,12: 642900.
[19] 马瑞英, 范俊柏, 崔海英, 等. Apelin/APJ系统与心血管,应激反应的研究进展 [J]. 中西医结合心脑血管病杂志, 2021,19(18): 3.
[20] 郭瑞敏, 范俊柏. 氟比洛芬酯镇痛预处理对糖尿病患者围术期氧化应激及Apelin的影响 [J]. 新医学, 2022,53(4): 254-259.
[21] Ter Horst E N, Krijnen P A J, Flecknell P, et al. Sufentanil-medetomidine anaesthesia compared with fentanyl/fluanisone-midazolam is associated with fewer ventricular arrhythmias and death during experimental myocardial infarction in rats and limits infarct size following reperfusion [J]. Lab Anim, 2018, 52(3): 271-279.
[22] Lee J, Kim S. The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: a randomized prospective study [J]. Medicine, 2019, 98(18): e15385.
基金
山西省医师协会医师临床科研项目(YSXH-RF2022MZ004)
PDF(1082 KB)
