目的 对比食管胃底静脉曲张(GEV)患者行无痛胃镜治疗采用瑞马唑仑与丙泊酚的麻醉效果。方法 选取2022-02至2024-02在青岛大学附属医院行无痛胃镜下精准治疗的98例GEV患者的临床资料进行回顾性研究,男65例,女33例,年龄18~75岁。按麻醉方法不同分为瑞马唑仑组和丙泊酚组,每组49例。静脉麻醉诱导3 min后,瑞马唑仑组静脉注射瑞马唑仑0.2 mg/kg,丙泊酚组静脉注射丙泊酚2 mg/kg,待患者睫毛反射消失后开始进行胃镜下精准治疗,治疗过程中分别以每次0.05 mg/kg追加瑞马唑仑或每次0.5 mg/kg追加丙泊酚。记录两组诱导前即刻(T0)、胃镜通过喉部时(T1)、操作开始后5 min(T2)、操作结束即刻(T3)时镇静起效时间、苏醒时间、离室时间以及不良反应情况(包括呃逆、头晕、恶心呕吐)。结果 与丙泊酚组比较,瑞马唑仑组T1、T2、T3心率(HR)、平均动脉压(MAP)均显著升高,T1、T2时脉搏SpO2、脑电双频指数(BIS)显著升高,差异有统计学意义(P<0.05),与丙泊酚组比较,瑞马唑仑组苏醒时间[(5.39±1.12)min vs.(6.64±0.97)min]、离室时间[(19.53±3.24)min vs.(24.32±3.76)min]明显缩短(P<0.05),但两组镇静起效时间无明显差异。瑞马唑仑组不良反应发生率明显低于丙泊酚组,其中呛咳、呃逆的发生率[8(16.33%)vs. 1(2.04%);13(26.53%)vs. 1(2.04%)]差异有统计学意义(P<0.05),心动过缓、体动的发生率无明显差异。结论 GEV患者进行无痛胃镜下精准治疗中应用瑞马唑仑效果显著,对血流动力学影响小于采用丙泊酚,且术后恢复更快。
Abstract
Objective To compare the anesthetic effects of remimazolam and propofol in painless gastroscopy for patients with gastroesophageal varices (GEV). Methods The clinical data of 98 patients with GEV who underwent precision treatment under painless gastroscopy in Affiliated Hospital of Qingdao University between February 2022 and February 2024 were retrospectively analyzed. There were 65 males and 33 females aged 18-75 years. The patients were divided into a remimazolam group and a propofol group according to different anesthesia methods, with 49 cases in each group. After 3 minutes of intravenous anesthesia induction, the patients received either 0.2 mg/kg remimazolam or 2 mg/kg propofol accordingly. Precision gastroscopy treatment began when eyelash reflex disappeared, with intraoperative top-ups of 0.05 mg/kg remimazolam or 0.5 mg/kg propofol administered as required. Data were recorded at four time points: pre-induction baseline (T0), gastroscope passage through the pharynx (T1), 5 minutes after procedure initiation (T2), and immediately post-procedure (T3). Measured outcomes included sedation onset time, recovery time, discharge readiness time, and adverse reactions (including hiccups, dizziness, and nausea/vomiting). Results Compared with the propofol group, the remimazolam group exhibited significantly higher heart rate (HR) and mean arterial pressure (MAP) at T1, T2 and T3, and the pulse SpO2 and bispectral index (BIS) were also significantly higher at T1 and T2, with statistically significant differences (P<0.05). Compared with the propofol group, the remimazolam group showed significantly shorter recovery time[(5.39±1.12)min vs. (6.64±0.97)min] and discharge time[(19.53±3.24) min vs. (24.32± 3.76)min; P<0.05], but there was no significant difference in the onset time of sedation between the two groups. The incidence of adverse reactions in the remimazolam group was significantly lower than that in the propofol group, with statistically significant differences in the incidence of coughing and hiccups[8(16.33%) vs. 1(2.04%); 13(26.53%) vs. 1(2.04%)](P<0.05), but there was no significant difference in the incidence of bradycardia and body movement. Conclusions The application of remimazolam in the precision treatment of GEV patients under painless gastroscopy is significantly effective, with less impact on hemodynamics than propofol, and the postoperative recovery is faster.
关键词
瑞马唑仑 /
丙泊酚 /
食管胃底静脉曲张 /
无痛胃镜 /
精准治疗
Key words
remimazolam /
propofol /
gastroesophageal varices /
painless gastroscopy /
precision treatment
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