【摘要】 目的 对比阿芬太尼联合瑞马唑仑和阿芬太尼联合丙泊酚在宫腔镜检查中的应用效果。方法 选择2022年4月至2024年9月在梅州市人民医院门诊手术室接受宫腔镜检查的80例患者，按随机数字表法分为A组和B组，每组各40例。其中A组予以阿芬太尼联合瑞马唑仑麻醉，B组予以阿芬太尼联合丙泊酚静脉麻醉。对比两组操作时间、苏醒时间及清醒时间，观察两组术前、术中、术后收缩压（SBP）、舒张压（DBP）、心率（HR）及血氧饱和度（SpO₂）及术后1、3、5分钟时改良清醒镇静评分（MOAA/S），对比两组术后不良反应发生率。结果 A组患者苏醒时间、清醒时间均较B组缩短（P<0.05）。A组麻醉优良率为95.00%（38/40）,B组为90.00%（36/40），差异无统计学意义（P>0.05）。不同时间点两组患者舒张压、心率和血氧饱和度比较，差异有统计学意义（P<0.05）。SBP、DBP、HR及SpO₂值均先降低后升高，且A组DBP、HR及SpO₂值均较B组升高（P<0.05）；两组SBP比较，差异无统计学意义（P>0.05）。两组不同麻醉方式和时间对血流动力学指标存在互相影响的交互作用（P<0.05）。随着时间增加，两组患者的MOAA/S评分在不同时间点下均呈升高趋势，差异有统计学意义（P<0.05）。不同时间点A组MOAA/S评分均较对照组升高（P<0.05）。MOAA/S评分受到不同麻醉方式和时间的交互作用（P<0.05）。A组呼吸抑制、注射痛发生率均较B组降低（P<0.05）。结论 阿芬太尼联合瑞马唑仑麻醉效果与丙泊酚相似，可维持宫腔镜检查患者血流动力学稳定，患者恢复清醒状态时间短，安全性较好，可安全有效地应用于宫腔镜检查。更多还原

【Abstract】 Objective To compare the effects of alfentanil combined with remimazolam or propofol in hysteroscopy. Methods A total of 80 patients who underwent hysteroscopy in the Outpatient Operating Room of Meizhou People’s Hospital from the month of April 2022 to September of 2024 were selected and separated into group A（alfentanil combined with remimazolam） and group B（alfentanil combined with propofol） according to the random number table method, with 40 cases in each group. Group A was anesthetized with alfentanil combined with remimazolam, and group B with alfentanil combined with propofol intravenous anesthesia. The operation time, awakening time and awakening time of the two groups were compared. The systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR） and blood oxygen saturation（SpO₂） before, during and after the operation, as well as the modified awake sedation score（MOAA/S） at 1 min, 3 min and 5 min after the operation were observed in the two groups. The incidence of adverse reactions after surgery was compared between the two groups. Results The awakening time and lucid time of patients in Group A were both shorter than those in Group B（P<0.05）. The excellent and good rate of anesthesia was 95.00%（38/40） in Group A and 90.00%（36/40） in Group B, with no statistically significant difference（P>0.05）. The comparison of DBP, HR, and SpO₂ values between two groups of patients at different time points showed statistically significant differences（P<0.05）. SBP, DBP, HR, and SpO₂ values all decreased first and then increased, and DBP, HR, and SpO₂ values in group A were higher than those in group B（P<0.05）; there was no statistically significant difference in SBP between the two groups（P>0.05）. Different anesthesia methods and duration had an interactive effect on hemodynamic indicators（P<0.05）. Overall, there was a significant difference in efficacy between the two groups, suggesting that different anesthesia methods and duration had an interactive effect on hemodynamic indicators（P<0.05）. The results showed that with the increase of time, the MOAA/S scores of patients in both groups showed an increasing trend at different time points, and the difference was statistically significant（P<0.05）. There was an interactive effect of different anesthesia methods and time on MOAA/S score（P<0.05）. The incidence rates of respiratory depression and injection pain in Group A were both lower than those in Group B（P<0.05）. Conclusion Alfentanil combined with remazolam anesthesia effect is similar to that of propofol, which can maintain the hemodynamic stability of hysteroscopy patients, and the time for patients to regain consciousness is short, with better safety, thus it can be safely and effectively applied to hysteroscopy.更多还原