| 刘慧芳,王经丽,何玉圆,金建萍,朵永丽.不同剂量瑞马唑仑联合阿芬太尼在儿童无痛胃镜中的应用[J].,2024,(14):2742-2746 |
| 不同剂量瑞马唑仑联合阿芬太尼在儿童无痛胃镜中的应用 |
| The Application of Different Doses of Remazolam Combined with Alfentanil in Painless Gastroscopy in Children |
| 投稿时间：2024-01-23 修订日期：2024-02-18 |
| DOI：10.13241/j.cnki.pmb.2024.14.027 |
| 中文关键词: 瑞马唑仑 阿芬太尼 无痛胃镜 儿童 镇静水平 生命体征 不良反应 |
| 英文关键词: Remazolam Afentanil Painless gastroscopy Children Calm level Vital signs Adverse reactions |
| 基金项目:甘肃省自然科学基金项目（20JR10RA423） |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量瑞马唑仑联合阿芬太尼在儿童无痛胃镜中的应用效果。方法：选取2023年5月到2023年11月收治的165例行无痛胃肠镜检查的患儿作为研究对象，应用随机数字表法将其分为四组，即R1（n=40）、R2（n=40）、R3组（n=40）及对照组（n=45）。对照组患者静脉注射丙泊酚2 mg/kg，阿芬太尼7 μg/kg，R1、R2、R3组静脉注射阿芬太尼7 μg/kg与瑞马唑仑，R1组瑞马唑仑为0.2 mg/kg。R2组为0.3 mg/kg，R3组为0.4 mg/kg，待所有患者改良警觉/镇静（MOAA/S）评分≤1分时开始进行胃镜检查。对比四组患儿镇静成功率、镇静起效时间、苏醒时间胃镜检查时间及补救镇静次数，分别在给药前、首次给药后、入镜前、检查结束即刻采取MOAA/S评分评价其镇静程度，记录四组患儿麻醉诱导前（T0）、进境时（T1）、结束后（T2）的心率（HR）、血压（BP）及血氧饱和度（SpO2）变化，最后对比四组患儿不良反应发生情况。结果：四组患者苏醒时间、胃镜检查时间对比无明显差异（P＞0.05），R3组患者镇静成功率明显高于R1组、R2组与对照组，镇静起效时间、补救镇静次数明显低于R1组、R2组与对照组（P＜0.05）；四组患者给药前、检查结束即刻MOAA/S评分对比无明显差异（P＞0.05），首次给药后、入镜前R3组患者MOAA/S评分明显低于R1组、R2组与对照组（P＜0.05）；四组患者T0、T1、T2时间血氧饱和度（SpO2）水平，T0、T2时间心率（HR）水平无明显变化，且四组对比无显著差异（P＞0.05），T2 R3组患者HR水平稳定，R1组、R2组与对照组出现明显波动，T1 R3组明显低于R1组、R2组与对照组（P＜0.05）；R1、R2、R3组患者注射痛、喉痉挛、低氧血症、低血压、心动过缓等不良反应发生率明显低于对照组（P＜0.05），但R1、R2、R3三组对比无明显差异（P＞0.05）。结论：瑞马唑仑联合阿芬太尼可提升儿童胃镜检查过程中的镇静效果，且瑞马唑仑采取0.4 mg/kg效果更优，可进一步改善镇静成功率，降低补救镇静次数，且不增加苏醒时间，镇静效果更好，可稳定患儿检查过程中的心率水平，安全性较高。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the application effect of different doses of remifentanil combined with remifentanil in painless gastroscopy in children. Methods: 165 pediatric patients who underwent painless gastroscopy from May 2023 to November 2023 were selected as the study subjects. They were randomly divided into four groups using a random number table method, namely R1 (n=40), R2 (n=40), R3 group (n=40), and Matched group (n=45). Patients in the Matched group were intravenously injected with 2 mg/kg propofol and 7% fentany l μg/kg, R1, R2, R3 groups intravenous injection of fentanyl 7 μg/kg and Remazolam, R1 group Remazolam is 0.2 mg/kg. The R2 group is 0.3 mg/kg, and the R3 group is 0.4 mg/kg. Gastroscopy should be performed when all patients have improved alertness/calmness (MOAA/S) scores ≤ 1. Compare the success rate of sedation, onset time of sedation, awakening time, gastroscopy examination time, and number of times of remedial sedation among four groups of children. Evaluate the degree of sedation using MOAA/S scores before administration, after initial administration, before endoscopy, and immediately after examination. Record the changes in heart rate, blood pressure, oxygen saturation, heart rate (HR), and blood oxygen saturation (SpO2) of the four groups of children before anesthesia induction (T0), at entry (T1), and after anesthesia induction (T2), Finally, compare the incidence of adverse reactions among the four groups of children. Results: There was no difference in the recovery time and gastroscopy examination time among the four groups of patients(P>0.05). The success rate of sedation in the R3 group was higher than that in the R1 group, R2 group, and Matched group. The onset time of sedation and the number of times of remedial sedation were lower than those in the R1 group, R2 group, and Matched group (P<0.05); There was no difference in MOAA/S scores among the four groups of patients before administration and immediately after examination(P>0.05). After the first administration and before endoscopy, the MOAA/S scores of R3 group patients were lower than those of R1 group, R2 group, and Matched group (P<0.05); There was no change in blood oxygen saturation (SpO2) levels and heart rate (HR) levels at T0, T1, and T2 time in the four groups of patients, and there was no difference between the four groups(P>0.05). The HR levels of patients in the T2 and R3 groups were stable, but there were fluctuations between the R1 and R2 groups and the Matched group. The T1 and R3 group was lower than the R1 and R2 groups and the Matched group (P<0.05); The incidence of adverse reactions such as injection pain, laryngeal spasm, hypoxemia, hypotension, and bradycardia in patients in R1, R2, and R3 groups was lower than that in the Matched group (P<0.05), but there was no difference in the comparison of R1, R2, and R3 groups(P>0.05). Conclusion: The combination of Remazolam and Alfentanil can improve the sedative effect during gastroscopy in children, and Remazolam at a dose of 0.4 mg/kg is more effective. It can further improve the success rate of sedation, reduce the number of times of remedial sedation, and do not increase the awakening time. The sedative effect is better, and it can stabilize the heart rate level during the examination of children, with higher safety. |
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