Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, Shandong 266071, People's Republic of China.
Department of Hepatobiliary Pancreatic Surgery, Qingdao Municipal Hospital, Qingdao, Shandong 266071, People's Republic of China.
Postgrad Med J. 2024 Aug 16;100(1187):635-641. doi: 10.1093/postmj/qgae040.
To investigate the impacts of remimazolam tosilate on gastrointestinal hormones and motility in patients undergoing gastrointestinal endoscopy with sedation.
A total of 262 American Society of Anesthesiologists Physical Status I or II patients, aged 18-65 years, scheduled for gastrointestinal endoscopy with sedation, were randomly allocated into two groups (n = 131 each): the remimazolam tosilate group (Group R) and the propofol group (Group P). Patients in Group R received 0.2-0.25 mg/Kg remimazolam tosilate intravenously, while those in Group P received 1.5-2.0 mg/kg propofol intravenously. The gastrointestinal endoscopy was performed when the Modified Observer's Assessment of Alertness/Sedation scores were ≤3. The primary endpoints included the endoscopic intestinal peristalsis rating by the endoscopist; serum motilin and gastrin levels at fasting without gastrointestinal preparation (T0), before gastrointestinal endoscopy (T1), and before leaving the Post Anesthesia Care Unit (T2); and the incidences of abdominal distension during Post Anesthesia Care Unit.
Compared with Group P, intestinal peristalsis rating was higher in Group R (P < .001); Group R showed increased motilin and gastrin levels at T2 compared with Group P (P < .01). There was a rise in motilin and gastrin levels at T1 and T2 compared with T0 and at T2 compared with T1 in both groups (P < .01). The incidence of abdominal distension was lower in Group R (P < .05).
Compared with propofol used during gastrointestinal endoscopy with sedation, remimazolam tosilate mildly inhibits the serum motilin and gastrin levels, potentially facilitating the recovery of gastrointestinal motility.
研究甲苯磺酸雷米唑仑对镇静胃肠镜检查患者胃肠激素和动力的影响。
选择美国麻醉医师协会身体状况 I 或 II 级、年龄 18-65 岁、拟行镇静胃肠镜检查的患者 262 例，采用随机数字表法分为两组（每组 131 例）：甲苯磺酸雷米唑仑组（R 组）和丙泊酚组（P 组）。R 组患者静脉注射 0.2-0.25mg/kg 甲苯磺酸雷米唑仑，P 组患者静脉注射 1.5-2.0mg/kg 丙泊酚。当改良观察者警觉/镇静评分≤3 时进行胃肠镜检查。主要终点包括内镜医师评估的肠道蠕动评分；禁食无胃肠准备时（T0）、胃肠镜检查前（T1）和离开麻醉后恢复室（T2）时的血清胃动素和胃泌素水平；麻醉后恢复室期间腹胀的发生率。
与 P 组相比，R 组肠道蠕动评分较高（P<0.001）；R 组 T2 时胃动素和胃泌素水平高于 P 组（P<0.01）。两组 T1 和 T2 时的胃动素和胃泌素水平均高于 T0 时，T2 时高于 T1 时（P<0.01）。R 组腹胀发生率较低（P<0.05）。
与镇静胃肠镜检查中使用的丙泊酚相比，甲苯磺酸雷米唑仑轻度抑制血清胃动素和胃泌素水平，可能促进胃肠动力恢复。
