Feasibility of using remimazolam alone in painless gastroscopy
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摘要:目的
探讨单纯应用瑞马唑仑在无痛胃镜检查中的可行性。
方法选取拟行无痛胃镜检查的350例患者作为研究对象，美国麻醉医师协会（ASA）分级为Ⅰ~Ⅱ级，将其随机分为7组，每组50例。R1组、R2组、R3组、R4组、R5组、R6组分别静脉注射瑞马唑仑0.30、0.35、0.40、0.45、0.50、0.55 mg/kg，对照组静脉注射丙泊酚2 mg/kg。若患者术中出现明显呛咳或体动反应，追加丙泊酚30~50 mg。记录各组患者镇静成功率，观察各组给药前和给药后1 min的平均动脉压（MAP）、心率（HR），并观察各组呛咳、体动、呃逆、低氧血症、注射痛等不良反应发生情况和胃镜检查时间、苏醒时间、离院时间。
结果R1组、R2组、R3组、R4组、R5组镇静成功率分别为16.0%、34.0%、38.0%、48.0%、58.0%，均低于对照组的82.0%，差异有统计学意义（P < 0.05）；R6组镇静成功率（72.0%）与对照组比较，差异无统计学意义（P>0.05）。与对照组比较，R1组、R2组、R3组、R4组、R5组、R6组呛咳、体动和呃逆发生率升高，低氧血症和注射痛发生率降低，离院时间延长，差异有统计学意义（P < 0.05）；R2组、R3组、R4组、R5组、R6组苏醒时间分别为（13.0±3.9）、（14.6±5.0）、（16.2±6.5）、（17.5±5.4）、（20.2±7.2）min，均长于对照组的（10.0±3.3）min，差异有统计学意义（P < 0.05）。R1组、R2组、R3组、R4组、R5组、R6组HR变化量高于对照组，差异有统计学意义（P < 0.05）。
结论在无痛胃镜检查中，单纯应用瑞马唑仑的镇静成功率与剂量呈正相关，其剂量达0.55 mg/kg时与2 mg/kg丙泊酚的镇静成功率相当，但瑞马唑仑会引起患者呛咳、体动和呃逆发生率升高，且苏醒时间和离院时间延长。
Abstract:ObjectiveTo explore the feasibility of using remimazolam alone in painless gastroscopy.
MethodsA total of 350 patients undergoing painless gastroscopy were selected as study objects, and they were Ⅰ to Ⅱ grade of American Society of Anesthesiologists (ASA) classification. They were randomly divided into seven groups, with 50 patients per group. Group R1, group R2, group R3, group R4, group R5, and group R6 were respectively injected 0.30, 0.35, 0.40, 0.45, 0.50 and 0.55 mg/kg of remimazolam, while control group injected 2 mg/kg of propofol intravenously. The dosage of 30 to 50 mg of propofol was added if the patient had obvious cough or body movement reaction during the operation. The success rates of sedation of different groups were recorded, and the mean arterial pressure (MAP) and heart rate (HR) were observed before drug administration and 1 min after drug administration. The occurrence of adverse reactions such as cough, body movement, hiccup, hypoxemia, injection pain, gastroscopy time, awakening time and discharge time were observed in each group.
ResultsThe success rates of sedation in the R1, R2, R3, R4 and R5 groups were 16.0%, 34.0%, 38.0%, 48.0% and 58.0%, respectively, which were lower than 82.0% in the control group, and the differences were statistically significant (P < 0.05). There was no significant difference in sedation success rate between R6 group (72.0%) and control group (P>0.05). Compared with the control group, the incidence rates of cough, body movement and hiccup in the R1, R2, R3, R4, R5 and R6 groups were increased, the incidence rates of hypoxemia and injection pain were decreased, and the time of leaving hospital was prolonged, and the differences were statistically significant (P < 0.05). The awakening time of the R2 group, R3 group, R4 group, R5 group and R6 group were (13.0±3.9) min, (14.6±5.0) min, (16.2±6.5) min, (17.5±5.4) min and (20.2±7.2) min, respectively, which were all longer than (10.0±3.3) min in the control group, and the differences were statistically significant (P < 0.05). The HR changes in the R1, R2, R3, R4, R5 and R6 groups were higher than those in the control group, and the differences were statistically significant (P < 0.05).
ConclusionIn painless gastroscopy, the sedation success rate of rematazolam alone is positively correlated with dosage, and the sedation success rate of rematazolam alone at a dosage of 0.55 mg/kg is comparable to that of propofol at a dose of 2 mg/kg. However, rematazolam can increase the incidence rates of cough, body movement and hiccup, and prolong the awakening time and discharge time.
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Keywords:
- remimazolam /
- propofol /
- painless gastroscopy /
- sedation
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表 1 7组患者一般资料比较(x±s)[n(%)]
组别 n 性别 年龄/岁 体质量/kg BMI/(kg/m2) 男 女 R1组 50 26(52.0) 24(48.0) 49.1±11.0 65.6±11.8 23.7±3.0 R2组 50 24(48.0) 26(52.0) 50.7±10.1 63.3±10.5 23.2±2.5 R3组 50 22(44.0) 28(56.0) 50.7±11.5 64.8±10.0 23.2±2.8 R4组 50 24(48.0) 26(52.0) 50.0±12.1 65.5±10.1 23.5±3.0 R5组 50 25(50.0) 25(50.0) 50.0±11.8 64.9±9.9 23.4±2.8 R6组 50 23(46.0) 27(54.0) 51.7±11.3 62.8±10.0 22.6±2.9 对照组 50 25(50.0) 25(50.0) 51.0±10.2 65.7±9.6 23.9±3.0 
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表 2 7组患者镇静成功、不良反应发生情况比较[n(%)]
组别 n 镇静成功 不良反应 呛咳 体动 呃逆 低氧血症 注射痛 R1组 50 8(16.0)* 28(56.0)* 32(64.0)* 16(32.0)* 2(4.0)* 1(2.0)* R2组 50 17(34.0)* 26(52.0)* 29(58.0)* 15(30.0)* 3(6.0)* 3(6.0)* R3组 50 19(38.0)* 24(48.0)* 25(50.0)* 12(24.0)* 2(4.0)* 2(4.0)* R4组 50 24(48.0)* 19(38.0)* 24(48.0)* 13(26.0)* 2(4.0)* 2(4.0)* R5组 50 29(58.0)* 15(30.0)* 19(38.0)* 16(32.0)* 4(8.0)* 2(4.0)* R6组 50 36(72.0) 14(28.0)* 16(32.0)* 14(28.0)* 4(8.0)* 1(2.0)* 对照组 50 41(82.0) 6(12.0) 7(14.0) 4(8.0) 10(20.0) 19(38.0) 与对照组比较, *P < 0.05。
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表 3 7组患者给药前后血流动力学指标变化情况比较(x±s)
组别 n MAP/mmHg HR/(次/min) 给药前 给药后1 min △MAP 给药前 给药后1 min △HR R1组 50 102.5±12.3 87.4±10.5* 15.0±10.1 73.0±8.8 80.0±10.0* 6.8±8.4# R2组 50 104.0±10.8 87.2±8.0* 16.8±7.5 72.5±11.9 82.2±15.8* 9.7±11.0# R3组 50 104.0±14.8 85.4±11.7* 18.6±10.0 74.6±13.5 81.8±13.2* 7.2±7.7# R4组 50 103.5±12.8 84.8±9.4* 18.7±11.0 73.5±11.8 80.9±12.3* 7.4±9.0# R5组 50 104.1±11.7 84.5±11.6* 19.6±8.7 75.7±12.0 83.5±11.1* 7.8±7.6# R6组 50 106.8±14.5 86.9±13.0* 19.9±11.7 72.4±11.4 81.9±9.8* 9.5±8.2# 对照组 50 106.1±12.2 88.7±12.3* 17.3±13.6 74.7±11.2 77.3±11.5* 2.6±10.0 MAP: 平均动脉压; HR: 心率; △MAP: 给药前后平均动脉压变化量; △HR: 给药前后心率变化量。
与给药前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 7组患者胃镜检查时间、苏醒时间和离院时间比较(x±s)
min 组别 n 胃镜检查时间 苏醒时间 离院时间 R1组 50 5.0±2.0 11.7±4.0 38.2±8.7* R2组 50 4.6±1.7 13.0±3.9* 42.9±9.1* R3组 50 4.9±1.4 14.6±5.0* 45.3±9.6* R4组 50 5.4±2.1 16.2±6.5* 49.3±8.6* R5组 50 4.7±1.4 17.5±5.4* 51.7±10.3* R6组 50 5.0±1.3 20.2±7.2* 55.8±9.9* 对照组 50 4.8±1.4 10.0±3.3 29.8±9.4 与对照组比较, *P < 0.05。
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