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[不同麻醉方案对无痛胃镜检查患者术后复苏速度和质量的影响]

[Impacts of different anesthetic protocols on the speed and quality of postoperative resuscitation in patients undergoing painless gastroscopy].

作者信息

Jia Z, Cai R Z, Zhao C C, Zhou B, Tan Z M

机构信息

Department of Anesthesiology, Affiliated Hainan Cancer Hospital of Hainan Medical College, Haikou 570100, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2024 Aug 13;104(31):2943-2948. doi: 10.3760/cma.j.cn112137-20240126-00203.

Abstract

To estimate the impacts of different anesthetic protocols on the speed and quality of postoperative resuscitation in patients undergoing painless gastroscopy. This was a prospectively designed randomized control study that included 150 patients who underwent painless gastroscopy in Hainan Cancer Hospital affiliated to Hainan Medical College between April and December of 2023. All the patients, classified as American Society of Aneshesiologists (ASA) Grade Ⅰ or Ⅱ, were randomly divided into three groups with different anesthetic protocols, including propofol group (group P), remimazolam group (group R) and remimazolam with flumazenil group (group RF). There were eventually 50 patients in each group. The three groups of patients were compared for their resuscitation time and the time that they stayed in the resuscitation room (addressed as"room time"below). At 10 min and 20 min after resuscitation, each patient was tested for recognition ability (orientation score), walking ability and fine motor skill (including reaction speed, quick-click ability and visual memory), respectively, with possible adverse reactions recorded spontaneously, such as hypotension, dizziness, nausea and vomitus. There were 29 males and 21 females in group P with an average age of (34±6) years, 27 males and 23 females in group R with an average age of (36±8) years, and 26 males and 24 females in group RF with an average age of (33±7) years, respectively. All examinations for each patient were successfully completed with no interruptions. The resuscitation time and room time of group RF were (47±15) s and (26±5) min,respectively, which were both shorter than those in either group R [(489±92) s and (35±6) min] or group P [(196±61) s and (31±7) min] (all <0.05). The orientation score of patients in group RF at 10 min after resuscitation was (79.0±10.5), which was significantly higher than that in group R (70.0±11.7) (<0.05). The patients' walking ability score of group RF at 10 min and 20 min after resuscitation were [(23.6±10.8), (48.0±4.5)], which were better than those in group R[(15.4±11.1), (47.6±4.8)] (both <0.05). The patients' reaction speed and quick-click scores of group RF were [(851.0±150.9), (547.0±114.0) ms] and [(758.0±73.2), (629.0±128.9) ms], which were better than those in either group R [(1 151.0±206.0), (732.0±135.1) ms], [(893.0±110.9), (765.8±125.8) ms] or group P [(985.0±225.3), (613.0±123.2) ms], [(831.0±87.7), (691.0±115.8) ms] (all <0.05). The incidence rate of hypotension in group P was 18% (9/50), higher than that in either Group R [4% (2/50)] or group RF [2% (1/50)] (all <0.05). The incidence rates of dizziness, nausea and vomitus were comparable among all the three groups with no statistical differences (all >0.05). In patients undergoing anesthesia with remazolam, the use of flumazenil can not only shorten the resuscitation time and the time that the patients need to stay in the resuscitation room, but also speed up the recovery of the patients' recognition, walking and fine motor skill abilities.

摘要

评估不同麻醉方案对无痛胃镜检查患者术后复苏速度和质量的影响。这是一项前瞻性设计的随机对照研究,纳入了2023年4月至12月在海南医学院附属海南肿瘤医院接受无痛胃镜检查的150例患者。所有患者均为美国麻醉医师协会(ASA)Ⅰ级或Ⅱ级,随机分为三组,采用不同的麻醉方案,包括丙泊酚组(P组)、瑞马唑仑组(R组)和瑞马唑仑复合氟马西尼组(RF组)。每组最终有50例患者。比较三组患者的复苏时间以及在复苏室停留的时间(以下简称“室间时间”)。复苏后10分钟和20分钟,分别测试每位患者的认知能力(定向评分)、行走能力和精细运动技能(包括反应速度、快速点击能力和视觉记忆),同时自行记录可能出现的不良反应,如低血压、头晕、恶心和呕吐。P组男性29例,女性21例,平均年龄(34±6)岁;R组男性27例,女性23例,平均年龄(36±8)岁;RF组男性26例,女性24例,平均年龄(33±7)岁。每位患者的所有检查均顺利完成,无中断情况。RF组的复苏时间和室间时间分别为(47±15)秒和(26±5)分钟,均短于R组[(489±92)秒和(35±6)分钟]及P组[(196±61)秒和(31±7)分钟](均P<0.05)。RF组患者复苏后10分钟的定向评分为(79.0±10.5),显著高于R组(70.0±11.7)(P<0.05)。RF组患者复苏后10分钟和20分钟的行走能力评分分别为[(23.6±10.8),(48.0±4.5)],优于R组[(15.4±11.1),(47.6±4.8)](均P<0.05)。RF组患者的反应速度和快速点击评分分别为[(851.0±150.9),(547.0±114.0)毫秒]和[(758.0±73.2),(629.0±128.9)毫秒],优于R组[(1151.0±206.0),(732.0±135.1)毫秒]、[(893.0±110.9),(765.8±125.8)毫秒]及P组[(985.0±225.3),(613.0±123.2)毫秒]、[(831.0±87.7),(691.0±115.8)毫秒](均P<0.05)。P组低血压发生率为18%(9/50),高于R组[4%(2/50)]和RF组[2%(1/50)](均P<0.05)。三组患者头晕、恶心和呕吐的发生率相当,差异无统计学意义(均P>0.05)。在接受瑞马唑仑麻醉的患者中,使用氟马西尼不仅可以缩短复苏时间和患者在复苏室所需停留的时间,还能加快患者认知、行走和精细运动技能能力的恢复。

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