急诊科使用瑞米唑仑进行程序性镇静：有效性和患者满意度的前瞻性研究。
Remimazolam for procedural sedation in the emergency department: a prospective study of effectiveness and patient satisfaction.
作者信息
Andreassen Sofus, Nielsen Vibe Maria Laden, Krarup Anne Lund, Kamp Annika, Andersen Dennis Møller, Krogh-Larsen Steven, Melgaard Dorte
机构信息
Department of Emergency Medicine and Trauma Centre, Aalborg University Hospital, Hobrovej 18-22, EMRUn, Aalborg, 9000, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
出版信息
Scand J Trauma Resusc Emerg Med. 2025 May 20;33(1):93. doi: 10.1186/s13049-025-01402-6.
BACKGROUND
Remimazolam (RM) is a novel ultra-short acting benzodiazepine. This study evaluates the safety of using RM for procedural sedation in the emergency department (ED) comparing its administration by registered nurse anaesthetists versus house officers in 1st year residency in emergency medicine and emergency medicine physicians without previous anaesthesiologic specialisation. Secondary aims were patient satisfaction and proportion of successful procedures.
METHODS
This prospective study was performed at the ED at Aalborg University Hospital from 10 May through 20 August 2024. Five emergency medicine physicians (group 1) started administering RM to patients after completion of training and direct supervision. Results were compared to patients sedated by two registered nurse anaesthetists (group 2) who had been administering RM more than 50 times before study start. Time was recorded during sedation and a questionnaire filled out immediately after the patient had awakened. T-tests or Mann-Whitney U tests were used to compare groups. Proportions were calculated with chi-square (χ) tests of proportion.
RESULTS
In group 1, 53 patients were sedated by emergency medicine physicians, and in group 2, 50 patients were sedated by registered nurse anaesthetists. No or mild respiratory adverse effects were observed in 97% of patients in group 1 versus 100% in group 2. Procedural amnesia was 93% in group 1 versus 90% in group 2. Patients were safe to be left unsupervised after a median of 15 min in both groups. Procedural success was 92% in group 1 versus 100% in group 2.
CONCLUSIONS
Severe respiratory adverse effects after sedation were rare in both groups. Most patients had amnesia and adequate pain relief for the procedure. The use of RM by physicians without anaesthesiologic specialisation is considered a safe and effective alternative for procedural sedation in the ED.
TRIAL REGISTRATION
The study was registered and approved as a quality study (ID 2017-011259) by the hospital administration.
背景
瑞米唑仑（RM）是一种新型超短效苯二氮䓬类药物。本研究评估了在急诊科（ED）使用RM进行程序性镇静的安全性，比较了由注册护士麻醉师与急诊医学第一年住院医师以及没有既往麻醉专科培训的急诊医学医师给药的情况。次要目标是患者满意度和成功完成操作的比例。
方法
本前瞻性研究于2024年5月10日至8月20日在奥尔堡大学医院急诊科进行。五名急诊医学医师（第1组）在完成培训并接受直接监督后开始给患者使用RM。将结果与两名注册护士麻醉师（第2组）镇静的患者进行比较，这两名注册护士麻醉师在研究开始前已使用RM超过50次。记录镇静过程中的时间，并在患者苏醒后立即填写问卷。使用t检验或曼-惠特尼U检验比较组间差异。比例采用卡方（χ）检验计算。
结果
第1组有53例患者由急诊医学医师进行镇静，第2组有50例患者由注册护士麻醉师进行镇静。第1组97%的患者未观察到或仅观察到轻度呼吸不良反应，第2组为100%。第1组的程序性遗忘率为93%，第2组为90%。两组患者在中位数为15分钟后均可安全地无需监督。第1组的操作成功率为92%，第2组为100%。
结论
两组镇静后严重呼吸不良反应均罕见。大多数患者有遗忘症且操作过程中疼痛缓解充分。没有麻醉专科培训的医师使用RM被认为是急诊科程序性镇静的一种安全有效的替代方法。
试验注册
该研究已由医院管理部门注册并批准为一项质量研究（ID 2017 - 011259）。
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