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瑞马唑仑与右美托咪定用于纤维支气管镜清醒经口气管插管的安全性和有效性:一项随机、双盲、对照试验。

The Safety and Efficacy of Remimazolam Compared to Dexmedetomidine for Awake Tracheal Intubation by Flexible Bronchoscopy: A Randomized, Double-Blind, Controlled Trial.

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.

Department of Anesthesiology, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, People's Republic of China.

出版信息

Drug Des Devel Ther. 2024 Mar 28;18:967-978. doi: 10.2147/DDDT.S446222. eCollection 2024.

Abstract

BACKGROUND

Remimazolam is a novel ultra-short-acting benzodiazepine sedative that has the potential to be an alternative for procedural sedation due to its rapid sedation and recovery, no accumulation effect, stable hemodynamics, minimal respiratory depression, anterograde amnesia effect, and specific antagonist. Here, we aimed to compare the safety and efficacy of remimazolam with dexmedetomidine for awake tracheal intubation by flexible bronchoscopy (ATI-FB).

METHODS

Ninety patients scheduled for ATI-FB were randomly divided into three groups, each consisting of 30 cases: dexmedetomidine 0.6 µg/kg + sufentanil (group DS), remimazolam 0.073 mg/kg + sufentanil (group RS), or remimazolam 0.093 mg/kg + sufentanil (group RS). The primary outcome was the success rate of sedation. Secondary outcomes were MOAA/S scores, hemodynamic and respiratory parameters, intubation conditions, intubation time, tracheal intubation amnesia, and adverse events.

RESULTS

The success rates of sedation in groups RS and DS were higher than that in group RS (93.3%, 86.7%, respectively, vs 58.6%; = 0.002), and intubation conditions were better than those in group RS ( < 0.05). Group RS had shorter intubation times than groups RS and DS ( = 0.003), and a higher incidence of tracheal intubation amnesia than group DS ( = 0.006). No patient in the three groups developed hypoxemia or hypotension, and there were no significant differences in oligopnea, PetCO, or bradycardia ( > 0.05).

CONCLUSION

In conclusion, both DS and RS had higher success rates of sedation, better intubation conditions, and minor respiratory depression, but RS, with its shorter intubation time, higher incidence of anterograde amnesia, and ability to be antagonized by specific antagonists, may be a good alternative sedation regimen for patients undergoing ATI-FB.

摘要

背景

雷米唑仑是一种新型的超短效苯二氮䓬类镇静剂,由于其具有快速镇静和恢复、无蓄积作用、血流动力学稳定、呼吸抑制作用轻微、顺行性遗忘作用和特异性拮抗剂等特点,有可能成为一种替代方案用于程序镇静。在这里,我们旨在比较雷米唑仑与右美托咪定用于清醒经支气管镜气管插管(ATI-FB)的安全性和有效性。

方法

将 90 例行 ATI-FB 的患者随机分为三组,每组 30 例:右美托咪定 0.6 µg/kg + 舒芬太尼(DS 组)、雷米唑仑 0.073 mg/kg + 舒芬太尼(RS 组)或雷米唑仑 0.093 mg/kg + 舒芬太尼(RS 组)。主要结局是镇静成功率。次要结局是 MOAA/S 评分、血流动力学和呼吸参数、插管条件、插管时间、气管插管遗忘和不良事件。

结果

RS 组和 DS 组的镇静成功率均高于 RS 组(分别为 93.3%、86.7%,均高于 58.6%; = 0.002),插管条件优于 RS 组( < 0.05)。RS 组的插管时间短于 RS 组和 DS 组( = 0.003),且气管插管遗忘发生率高于 DS 组( = 0.006)。三组均无患者发生低氧血症或低血压,呼吸浅慢、PetCO 或心动过缓的发生率无显著差异( > 0.05)。

结论

总之,DS 和 RS 均具有较高的镇静成功率、更好的插管条件和较小的呼吸抑制作用,但 RS 具有较短的插管时间、较高的顺行性遗忘发生率和特异性拮抗剂拮抗作用,可能是 ATI-FB 患者的一种良好替代镇静方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5447/10984194/bd5763619dc8/DDDT-18-967-g0001.jpg

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