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瑞马唑仑与丙泊酚用于老年患者行胃肠道内镜查验的比较:一项前瞻性、赶快对照商榷

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贵州医科大学    麻醉与腹黑电生理课题组

翻译：吴学艳  剪辑：马艳燕  审校：曹莹

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01配景

甲苯磺酸瑞马唑仑(HR7056，RT)是一种新式的超短效苯二氮卓类药物，可用于身手逍遥和全身麻醉；然则，很少有商榷珍贵RT在老年患者胃肠道内镜查验中的逍遥作用；本商榷的想法是比较RT与丙泊酚对老年患者行胃肠道内镜查验中的逍遥后果。

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02步骤

商榷纳入2021年1月至2021年8月行胃肠内镜查验的美国麻醉医师学会(ASA)I-II级，体重指数(BMI)为18.0～30.0 kg/m2、年事≥65岁的82例患者，赶快分为RT组和丙泊酚组；两组均选择阿芬太尼5μg/kg镇痛；RT组赐与瑞马唑仑0.15 mg/kg，凭据需要追加剂量为0.05 mg/kg，丙泊酚组赐与丙泊酚1.5 mg/kg，追加剂量为0.5 mg/kg；补充剂量由修订警悟/逍遥评分(MOAA/S)和患者的体魄畅通决定。细察方针为：逍遥后果，如意志丧失机间(LOC) (MOAA/S评分≤1)、单次给药逍遥胜仗、携带胜仗后追加剂量、复原手艺等。逍遥联系的反作用的评估：如打针疾苦、血流能源学事件和呼吸附近；纪录术后恶心吐逆(PONV)、休息时视觉模拟评分(VAS)、止痛调养、头晕或头痛；此外，还比较两组患者及手术医师对麻醉后果的陶然度。

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03附近

对77例患者数据进行分析，两组患者逍遥胜仗率均为100%；RT组LOC手艺(MOAA/S评分≤1)较丙泊酚组长(20.7±6.1s 与 13.2±5.2s， P<0.001)；RT组阐述打针疾苦的患者少于丙泊酚组(0/39与5/38， P= 0.025)；RT组血流能源学事件和呼吸附近发生率均低于丙泊酚组(6/39 与 17/38，P=0.005)，(2/39与9/38，P=0.026)；RT组携带胜仗后追加药物剂量大于丙泊酚组(4/9/11/13/1/1 与 8/4/18/6/2/0，需要0、1、2、3、4、5次追加药物，P = 0.014)；两组患者术后细察方针及患者与医师的陶然度相通。

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04

论断：与丙泊酚组比较，RT可安全、灵验地用于老年患者行胃肠道内镜查验，逍遥联系不良反馈，尤其是血流能源学事件和呼吸附近的发生率更低；当使用RT时，携带胜仗后的追加剂量可能略有加多。

原始文件源泉: Guo J，男女扒开双腿猛进入免费看污 Qian Y， Zhang X， et al. Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective， randomized and controlled study. BMC Anesthesiol[J].2022 Jun 10;22(1):180. DOI: 10.1186/s 12 871-022-01713-6. 

英文原文：

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Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective， randomized and controlled study

Background: Remimazolam tosilate (HR7056， RT)， a novel ultrashort-acting benzodiazepine， can be used for procedural sedation and general anaesthesia. However， few studies have focused on the sedative effect of RT during gastrointestinal endoscopy in elderly patients. The purpose of this study is to compare the sedative effect of RT and propofol for gastrointestinal endoscopy in elderly patients.

Methods: A total of 82 patients aged ≥65 years with an American Society of Anaesthesiologists (ASA) grade I-II and a body mass index (BMI) of 18.0 to 30.0 kg/m2 who were scheduled for gastrointestinal endoscopy from Jan 2021 to Aug 2021 were selected and randomly divided into a RT group and a propofol group. Alfentanil 5 μg/kg was used for analgesia in both groups. The RT group was given remimazolam tosilate 0.15 mg/kg with supplemental doses of 0.05 mg/kg as need， while the propofol group was given propofol 1.5 mg/kg with supplemental doses of 0.5 mg/kg. The supplemental doses were determined by the modified observational alertness/sedation assessment (MOAA/S) score and the patients' body movements. Sedative effects， such as the time to loss of consciousness (LOC) (MOAA/S score ≤ 1)，青青草原综合久久大伊人精品 successful sedation in one dose， number of supplemental doses after successful induction， and recovery time， were evaluated. Sedation-related side effects， such as injection pain， haemodynamic events and respiratory depression， were also noted. Postoperative nausea and vomiting (PONV)， visual analogue scale (VAS) scores at rest， remedial analgesics， and dizziness or headache were recorded. In addition， patients' satisfaction and physician's satisfaction of the procedure were compared between the two groups.

Results: Data from 77 patients were analysed. The success rate of sedation in both groups was 100%. The time to LOC (MOAA/S score ≤ 1) in the RT group was longer than that in the propofol group (20.7 ± 6.1s vs. 13.2 ± 5.2s， P < 0.001). There were fewer patients in the RT group reporting injection pain than that in the propofol group (0/39 vs. 5/38， P = 0.025). Haemodynamic events and respiratory depression in the RT group were less frequent than those in the propofol group ((6/39 vs. 17/38， P = 0.005)， (2/39 vs. 9/38， P = 0.026)， respectively). The number of supplemental doses after successful induction in the RT group was greater than that in the propofol group (4/9/11/13/1/1 vs. 8/4/18/6/2/0 requiring 0， 1， 2， 3， 4 or 5 supplemental doses， P = 0.014). The characteristics of the patients enrolled， postoperative parameters of the patients， and patients' and physician's satisfaction of the procedure were comparable in the two groups.

Conclusions: Compared with propofol， RT can be safely and effectively used for gastrointestinal endoscopy sedation in elderly patients， and the incidence of sedation-related adverse reactions， especially haemodynamic events and respiratory depression， is lower. When RT is used， the number of supplemental doses after successful induction may increase slightly.

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