瑞马唑仑在儿童无痛胃镜检查中的应用
| 作者: |
1,2拾翠翠,
2孙剑,
2张玉凤
1 扬州大学医学院，江苏 扬州 225009 2 淮安市妇幼保健院麻醉科，江苏 淮安 223002 |
| 通讯: |
张玉凤
Email: zyfhafy1989@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.12.027 |
摘要
目的：评价瑞马唑仑在儿童无痛胃镜检查中的安全性及有效性。方法：选择淮安市妇幼保健院行无痛胃镜检查患儿60例，性别不限，年龄1~6岁，体重9~28 kg，美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级I或II级，随机分丙泊酚组(P组)与瑞马唑仑组(R组)，每组各30例。所有患儿胃镜检查开始前3 min单次静脉注射芬太尼1 μg/kg，P组静脉注射丙泊酚2 mg/kg，R组静脉注射瑞马唑仑0.2 mg/kg。待患儿改良警觉/镇静量表(Modified Observer’s Assessment of Alertness/Sedation Scale，MOAA/S)评分达3分时开始进行胃镜操作。若第1次静脉注射丙泊酚或瑞马唑仑后不能达到有效镇静深度，1 min后行补救镇静，P组追加丙泊酚0.5 mg/kg，R组追加瑞马唑仑0.05 mg/kg，累计追加次数最多为5次。开始胃镜检查后，根据患儿情况，给予丙泊酚0.5 mg/(kg·次)或瑞马唑仑0.05/(kg·次)，维持一定镇静深度。记录患儿MOAA/S镇静评分、镇静开始时间、苏醒时间、SpO2、HR、血压、补救镇静给药情况及镇静成功率，同时记录患儿低血压、心动过缓、低氧血症、喉痉挛、注射痛等不良反应发生情况。结果：与P组相比，R组镇静起效时间明显延长，但苏醒时间明显缩短(P<0.05)；两组患儿镇静成功率均为100%；R组补救镇静率显著高于P组(90% vs 60%，P<0.05)，且R组平均药物追加次数显著高于P组(P<0.01)；在不良反应方面，R组低血压及注射痛的发生率显著减少(P<0.05)。结论：瑞马唑仑可安全有效地用于儿童无痛胃镜检查，但最佳剂量还需进一步探索。与丙泊酚相比，不良反应发生率显著减少，镇静成功率均为100%。
关键词：
无痛胃镜检查；镇静；丙泊酚；瑞马唑仑；不良反应
Application of remimazolam in children during painless gastroscopy
CorrespondingAuthor: ZHANG Yufeng Email: zyfhafy1989@163.com
DOI: 10.3978/j.issn.2095-6959.2021.12.027
Abstract
Objective: To evaluate the safety and efficacy of remimazolam in children during painless gastroscopy. Methods: A total of 60 children were selected and randomly divided into a propofol group (group P, n=30) and a remimazolam group (group R, n=30), with no gender limitation, age 1–6 years old, weight 9–28 kg, American Society of Anesthesiologists Score I or II. All children were intravenously injected with fentanyl 1 μg/kg 3 minutes before the painless gastroscopy examination, and then a dose of propofol 2 mg/kg or remimazolam 0.2 mg/kg was injected intravenously in group P or group R. Gastroscopy was started when the Modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) reaching 3 points. In case of insufficient sedation after the first intravenous injection of propofol or remimazolam, remedial sedation was performed 1 minute later with propofol 0.5 mg/kg or remimazolam 0.05 mg/kg. Children could receive a maximum of 5 remimazolam or propofol doses. After starting gastroscopy, the depth of sedation was maintained by administering propofol 0.5 mg/kg or remimazolam 0.05 mg/kg each time. The MOAA/S score, sedation onset time, recovery time, SpO2, HR, blood pressure, the rate of rescue sedation, and successful sedation were all recorded. At the same time, we recorded the incidence of hypotension, bradycardia, hypoxemia, laryngeal spasm, injection pain and other adverse reactions. Results: Compared with group P, the onset time of sedation in group R was significantly longer, but the recovery time was significantly shorter (P<0.05). The rate of successful sedation in both groups was 100%. The remedial sedation rate of group R was significantly higher than that of group P (90% vs 60%, P<0.05), and the number of additional medications in group R was significantly higher than that of group P (P<0.01). In terms of adverse reactions, the incidence of hypotension and injection pain in group R was significantly decreased (P<0.05). Conclusion: Remimazolam is safe and effective for children during painless gastroscopy, and we need further explore about the optimal dosage. Compared with propofol, its incidence of adverse reactions is significantly reduced, and the rate of successful sedation is 100%.
Keywords：
painless gastroscopy; sedation; propofol; remimazolam; adverse reactions