【摘要】 目的:探索苯磺酸瑞马唑仑在老年无痛胃肠镜检查中的应用价值及对患者血流动力学的影响。方法:选择行无痛胃肠镜检查的老年患者60例,随机分为两组,A组为丙泊酚联合阿芬太尼,B组为苯磺酸瑞马唑仑联合阿芬太尼,每组30例,A组丙泊酚1～2 mg/kg复合阿芬太尼4μg/kg, B组苯磺酸瑞马唑仑7 mg复合阿芬太尼4μg/kg;睫毛反射消失后开始内镜检查,如术后发生体动反应分别追加丙泊酚0.2～0.5 mg/kg或苯磺酸瑞马唑仑3 mg;记录患者麻醉诱导前（T₁）、胃镜通过喉部（T₂）、肠镜时（T₃）、肠镜通过肝区（T₄）、检查结束时（T₅）时的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂）,起效时间、苏醒时间、离室时间以及不良反应（包括呛咳、体动反应、呼吸抑制、注射痛、谵妄等）的发生率。结果:两组间比较:MAP在T₂时点,HR在T₂、T₃、T₄时点比较差异有统计学意义（均P<0.05）,SpO₂两组比较各时点差异无统计学意义（P>0.05）。组内比较:A组MAP T₁时点比T₂、T₃、T₄时点降低差异有统计学意义（P<0.05）,T₂时点比T₃、T₄、T₅时点升高差异有统计学意义（均P<0.05）,T₃时点比T₅时点升高差异有统计学意义（P<0.05）;B组MAP T₁时点比T₂、T₃、T₄、T₅时点降低差异有统计学意义（均P<0.05）;A组HR T₁与T₂、T₃、T₄比较差异有统计学意义（均P<0.05）,T₂比T₄、T₅升高差异有统计学意义（均P<0.05）,T₃比T₅升高差异有统计学意义（P<0.05）。B组HR T₁比T₂、T₃下降差异有统计学意义（P<0.05）。两组SpO₂ 在T₁时点与T₂、T₃、T₄、T₅比较均升高,差异有统计学意义（均P<0.05）。B组起效时间较A组长,B组苏醒时间较A组短,两组差异均有统计学意义（均P<0.05）,两组患者离室时间比较差异无统计学意义（P>0.05）。B组的呛咳发生率较A组高,A组呼吸抑制、嗜睡、头晕、恶心呕吐、谵妄发生率较B组高,两组比较差异均有统计学意义（均P<0.05）。结论:苯磺酸瑞马唑仑联合阿芬太尼用于老年患者无痛胃肠镜的麻醉时循环稳定、呼吸抑制较轻,苏醒完全且不良反应发生率低。更多还原

【Abstract】 Objective:To explore the application of remimazolam besylate in elderly patients with painless gastrointestinal endoscopy and its effect on hemodynamics.Methods:Sixty elderly patients who underwent painless gastrointestinal endoscopy were randomly divided into two groups, 30 cases in each group.Group A was treated with propofol 1 to 2 mg/kg and alfentanil 4 μg/kg, and group B was treated with remimazolam besylate 7 m g and alfentanil 4 μg/kg.After the eyelash reflex disappeared, the endoscopy was started.If the body movement occurred after the operation, propofol 0.2 to 0.5 mg/kg or remimazolam besylate 3 mg were added.MAP,HR,SpO₂ before anesthesia（T₁）,gastroscopy through the larynx（T₂）,at the beginning of colonoscopy（T₃）,colonoscopy through the liver area（T₄）,awakening（T₅）,onset time, wake-up time, departure time and adverse reactions（including choking, body movement reaction, respiratory depression, injection pain, delirium, etc.） were recorded.Results:There was significant difference in MAP at T₂ and HR at T₂,T₃ and T₄ between two groups（all P<0.05）,but there was no significant difference in SpO₂ at each time point（all P>0.05）.In group A,MAP at T₁ was significantly lower than that at T₂,T₃ and T₄,and MAP at T₂ was significantly higher than that at T₃,T₄ and T₅,and MAP at T₃ was significantly higher than that at T₅ （all P<0.05）.In group B,MAP at T₁ was significantly lower than that at T₂,T₃,T₄ and T₅ （all P<0.05）.In group A,there was significant difference between HR at T₁ and that at T₂,T₃ and T₄,and HR at T₂ was significantly higher than that at T₄ and T₅,and HR at T₃ was significantly higher than that at T₅ （all P<0.05）.In group B,HR at T₁ was significantly lower than that at T₂ and T₃ （all P<0.05）.In two groups, SpO₂ at T₁ was significantly higher than that at T₂,T₃,T₄ and T₅ （all P<0.05）.The onset time of group B was longer than that of group A,and the wake-up time of group B was shorter than that of group A（all P<0.05）.There was no significant difference in departure time between the two groups（P>0.05）.The incidence of choking cough in group B was higher than that in group A,and the incidences of respiratory depression, drowsiness, dizziness, nausea, vomiting and delirium in group A were higher than those in group B（all P<0.05）.Conclusion:remimazzolam besylate combined with alfentanil for painless gastrointestinal endoscopy in elderly patients has stable circulation, mild respiratory inhibition, complete wake-up and low incidence of adverse reactions.更多还原