【作者】 王刚；

【导师】 张红；

【作者基本信息】 石河子大学 ， 临床医学（专业学位）， 2024， 硕士

【摘要】 目的:探讨瑞马唑仑复合依托咪酯用于老年无痛胃镜检查麻醉的安全性和有效性。方法:选择拟于本院胃镜中心行无痛胃镜检查术的老年患者135例,年龄65岁-85岁,ASAⅠ-Ⅱ级。按随机数字表法分为3组,瑞马唑仑-依托咪酯组（RE组）、丙泊酚组（P组）、瑞马唑仑（R组）,每组45例。给予负荷剂量阿芬太尼7μg/kg进行镇痛后,RE组静脉推注瑞马唑仑0.15mg/kg-依托咪酯0.15mg/kg、P组静脉推注丙泊酚2mg/kg静脉注射、R组静脉推注瑞马唑仑0.2mg/kg进行麻醉诱导。当患者的睫毛反射消失、无体动反应并经过评估后Ra msay评分>1分且改良警觉/镇静评分（Modified Alertness and Sedation Score,MOAA/S评分）<3分时开始进镜行胃镜检查。观察并记录麻醉诱导前（T0）、进镜时（T1）、给药后3min（T2）和给药后5min（T3）时3组患者的平均动脉压（Mean Arterial Pressure,MAP）、心率（Heart Rate,HR）和血氧饱和度（Pulse Oxygen Saturation,SpO₂）。同时,记录3组患者行胃镜检查所用的时间、术后苏醒时间、复苏室停留时间及相关不良事件的发生情况。使用MMSE（Mini-mental State Examination,MMSE）评分量表和Holden步行等级评分量表评估3组患者术后认知功能和运动能力的恢复情况,用VAS视觉模拟评分量表（Visual Analogue S cale,VAS）评估3组患者的术后疼痛情况。结果:本研究纳入的135名患者的一般信息均有均衡可比性。（1）3组患者之间镇静成功率无明显差异。与P组相比,RE、R组术后苏醒时间、恢复室停留时间更短,差异有统计学意义（P<0.05）。（2）RE组在T1、T2、T3三个时间的MAP值高于P组、R组（P<0.05）。RE组在T1、T2、T3时间点的HR、SpO₂值高于P组（P<0.05）。RE组在T1、T2、T3时间点的HR、SpO₂值与R组相比无明显差异（P>0.05）。（3）RE组的低血压、呼吸抑制的发生率均低于P组（P<0.05）。3组之间患者的呃逆、呛咳反应、恶心呕吐、头晕头痛及使用血管活性药等不良反应的发生率无明显差异（P>0.05）。P组的静脉注射痛发生率高于其他2组（P<0.05）。（4）RE组VAS评分与P组、R组相比无明显差异（P>0.05）。RE组术后MMSE评分高于P组（P<0.05）。RE组术后Holden评分高于P组（P<0.05）。RE组患者的满意度高于P组、R组（P<0.05）。结论:使用瑞马唑仑复合依托咪酯的老年患者在无痛胃镜检查中血流动力学更稳定、不良反应发生率更低,恢复质量更高,可安全有效地用于老年无痛胃镜检查。更多还原

【Abstract】 Objective:The aim is to assess the safety and efficacy of combining remazolam with etomidate for anesthesia in elderly patients receiving painless gastroscopy.Method:The Gastroscopy Center chose 135 senior patients,ranging in age from 65 to 85 and classified as ASA grade Ⅰ-Ⅱ,for a painless gastroscopy procedure.Utilizing the random number table approach,patients were categorized into three segments:remazolam-etomidate（RE）,propofol（P）,and remazolam（R）groups,each containing 45 instances.After loading dose of afentanil 7μg/kg for analgesia,Remazolam（0.15mg/kg）-etomidate（0.15mg/kg）was injected intravenously in the RE group,propofol（2mg/kg）was injected intravenously in the P group and remazolam（0.2mg/kg）was injected intravenously in the R group for anesthesia induction.When the patient’s eyelash reflexes disappeared,there was no body motor response,Ramsay Score>1 and Modified Alertness and Sedation Score（MOAA/S score）<3,gastroscopy began.Observe and record the mean arterial pressure（MAP）,heart rate（HR）,and pulse oxygen saturation（SpO₂）of three groups of patients at four different time points:before anesthesia induction（T0）,during intubation（T1）,3 minutes after administration of medication（T2）,and 5 minutes after administration of medication（T3）.Meanwhile,the time required for endoscopy,postoperative awakening time,recovery room stay time,and related adverse events were recorded for the 3 groups of patients.The Mini-mental State Examination（MMSE）scoring system and the Holden Walking Scale were used to evaluate the recovery of cognitive function and mobility in the 3 groups of patients after surgery,and three groups of patients post-surgery underwent pain evaluation using the Visual Analogue Scale（VAS）.Result:The general information of 135 patients included in this study was balanced and comparable.（1）Sedation effectiveness showed no notable variance between the trio of groups.In contrast to the P group,the RE and R groups experienced reduced postoperative recuperation and recovery room durations,with this variance being statistically meaningful（P<0.05）.（2）Relative to the P,R groups,the RE group exhibited elevated mean arterial pressure at T1,T2,and T3,with these variances being statistically meaningful（P<0.05）.In the RE group,the heart rate and oxygen levels at T1,T2,and T3 surpassed those in the P group,with a statistically notable difference（P<0.05）.No notable disparities were observed in the heart rate and oxygen levels of the RE group at the T1,T2,and T3 intervals when contrasted with the R group（P>0.05）.（3）In the RE group,occurrences of hypotension and respiratory depression were less frequent compared to the P group,with a statistically notable difference（P<0.05）.No notable variances were observed in the occurrence of hiccup,coughs,nausea,vomiting,dizziness,headaches,and vasoactive drug usage across the three groups（P>0.05）.Group P experienced more intravenous pain compared to the other two groups,with a statistically notable difference（P<0.05）.（4）There was no notable disparity in the post-surgery pain rating between the RE group and the P and R groups（P>0.05）.In the RE group,the MMSE score surpassed that of the P group,with a statistically notable disparity（P<0.05）.The Holden score for the RE group surpassed that of the P group,with a statistically notable difference（P<0.05）.Patient contentment in the RE group surpassed that in the P and R groups,with a statistically notable disparity（P<0.05）Conclusion:Remazolam combined with etomidate in elderly patients in painless gastroscopy has more stable hemodynamics,lower incidence of adverse reactions,higher recovery quality,and can be safely and effectively used in elderly patients in painless gastroscopy.更多还原