【摘要】 目的 比较无痛胃肠镜手术麻醉应用不同剂量苯磺酸瑞马唑仑联合丙泊酚对于肥胖患者呼吸循环系统的影响。方法 选取2024年4—8月包头市中心医院行无痛胃肠镜的肥胖患者112例为研究对象。随机分为4组：丙泊酚组（A组）30例、苯磺酸瑞马唑仑低剂量组（B组）27例、苯磺酸瑞马唑仑中剂量组（C组）25例、苯磺酸瑞马唑仑大剂量组（D组）30例。A组患者静脉注射舒芬太尼注射液5μg,丙泊酚2 mg/kg。B组、C组、D组患者静脉注射舒芬太尼注射液5μg,分别静脉注射苯磺酸瑞马唑仑0.05 mg/kg、0.075 mg/kg、0.1 mg/kg,随后给予丙泊酚1 mg/kg。记录各组患者入室后（T₀）、胃镜过喉时（T₁）、肠镜开始（T₂）、肠镜过肝区（T₃）、检查结束时（T₄）5个时间点的收缩压（SBP）、心率、血氧饱和度（SpO₂）、脑电双频指数值。观察麻醉过程中是否出现低氧血症、呛咳、低血压、注射痛、诱导时患者躁动、心动过缓等不良事件的发生。结果 B组、C组、D组患者T₁～T₄时间点的SpO₂值均高于A组（P<0.05）。与A组不良事件对比，B组、C组、D组低氧血症、注射痛、低血压、诱导时躁动发生率降低（P<0.05）。与C组比较，B组和D组低血压的发生率明显降低（P<0.05）。B组在T₁～T₄时SBP高于C组（P<0.05）。结论 不同剂量苯磺酸瑞马唑仑联合丙泊酚对于肥胖患者无痛胃肠镜的麻醉效果存在差异，数据证实了0.05 mg/kg苯磺酸瑞马唑仑联合丙泊酚的麻醉效果更佳，能更好地减轻呼吸循环的抑制、减少麻醉期间不良事件的发生。更多还原

【Abstract】 Objective To compare the effects of remazolam besylate combined with propofol on respiratory and circulatory system in obese patients undergoing painless gastroscopy.Methods A total of 120 obese patients who underwent painless gastroscopy and colonoscopy at Baotou Central Hospital from April to August 2024 were enrolled as study subjects. They were randomly divided into four groups: Propofol group（Group A）, remazolam besylate low-dose group（Group B）, remazolam besylate medium-dose group（Group C）, remazolam besylate high-dose group（Group D）. Patients in group A received sufentanil 5 μg and propofol 2 mg/kg intravenously. Patients in groups B, C, and D were given sufentanil injection 5μg, remazolam besylate 0.05 mg/kg, 0.075 mg/kg, 0.1 mg/kg, and propofol 1 mg/kg. Systolic blood pressure（SBP）, heart rate（HR）, oxygenation activity（SpO₂） and bispectral index（BISPECTRAL index） were recorded at five time points: after entering the room（T₀）, when gastroscopy passed through the larynx（T₁）, when enteroscopy began（T₂）, when enteroscopy passed through the liver（T₃） and at the end of examination（T₄）. The adverse events such as hypoxemia, cough, hypotension, injection pain, agitation and bradycardia during induction were observed. ResultsThe SpO₂ values from T₁ to T₄ in Group B, C and D were higher than those in group A（P<0.05）.Compared with group A, the incidence of hypoxemia, injection pain, hypotension and agitation during induction in group B, C and D decreased（P<0.05）.The incidence of hypotension in group B and D was significantly lower than that in group C（P<0.05）.SBP was higher in group B at T₁ to T₄ than in group C（P<0.05）. Conclusion There are differences in the anesthetic effect of remazolam besylate combined with propofol in different doses for painless gastroscopy in obese patients. The data confirm that remazolam besylate combined with propofol at 0.05 mg/kg has better anesthetic effect, can better alleviate the inhibition of respiration and circulation, reduce the occurrence of adverse events during anesthesia.更多还原