国际麻醉学与复苏杂志   2024, Issue (2): 12-12
    
瑞马唑仑用于肝硬化患者食管胃静脉曲张 内镜检查镇静效果的量效关系
樊芳菲, 邓莉1()
1.青海大学附属医院
Dose‑response relationship of remimazolam for sedation in patients suffering from liver cirrhosis undergoing endoscopy examination for esophagogastric varices
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摘要：

目的 探讨瑞马唑仑用于肝硬化患者食管胃静脉曲张内镜检查镇静效果的量效关系。 方法 纳入2021年6月—2022年8月于青海大学附属医院行食管胃静脉曲张内镜检查的肝硬化患者40例，年龄18~65岁，美国麻醉医师协会分级Ⅱ、Ⅲ级，体重指数（BMI）18.5~27.9 kg/m2，Child‑Pugh A级。患者先静脉注射舒芬太尼0.15 μg/kg，2 min后静脉注射瑞马唑仑。瑞马唑仑初始剂量设定为0.15 mg/kg（剂量梯度0.025 mg/kg），使用改良Dixon序贯法决定下一例患者的瑞马唑仑剂量。记录镇静成功和镇静失败的患者例数，并将患者分为镇静成功组（21例）和镇静失败组（19例）。记录两组患者白蛋白、谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBil）水平，苏醒时间、麻醉后监测治疗室（PACU）停留时间，术中呼吸抑制、低血压、心动过缓及术后头晕、恶心呕吐、苏醒延迟、躁动的发生情况。使用Probit回归分析计算瑞马唑仑用于肝硬化患者食管胃静脉曲张内镜检查镇静效果的半数有效量（ED50）和95%有效量（ED95）。 结果 瑞马唑仑用于肝硬化患者食管胃静脉曲张内镜检查的ED50及其95%置信区间（CI）为0.105（0.095~0.115） mg/kg，ED95及其95%CI为0.141（0.116~0.166） mg/kg。两组患者白蛋白、ALT、AST、TBil水平，苏醒时间、PACU停留时间，术中呼吸抑制、低血压、心动过缓及术后头晕、恶心呕吐、苏醒延迟、躁动的发生率比较，差异无统计学意义（均P>0.05）。 结论 瑞马唑仑用于肝硬化患者食管胃静脉曲张内镜检查的ED50、ED95分别为0.105、0.141 mg/kg。
关键词： 瑞马唑仑； 食管静脉曲张； 内镜检查术； 肝硬化； 量效关系
Abstract:

Objective To evaluate the dose‑response relationship of remimazolam for sedation in cirrhosis patients undergoing endoscopy for esophagogastric varices. Methods A total of 40 cirrhotic patients, aged 18‒65 years, with American Society of Anesthesiologists grades Ⅱ and Ⅲ, body mass index (BMI) 18.5‒27.9 kg/m2 and Child‑Pugh grade A, who underwent endoscopy for esophagogastric varices in Affiliated Hospital of Qinghai University from June 2021 to August 2022 were included. The patients were first intravenously injected with sufentanil at 0.15 μg/kg followed by remimazolam 2 min later. The initial dose of remimazolam was set at 0.15 mg/kg (with a dose gradient of 0.025 mg/kg), and the modified Dixon sequential method was used to determine the dose of remimazolam in the next patient. The number of patients with successful sedation and failed sedation was recorded, and the patients were divided into two groups: a successful sedation group (n=21) and a failed sedation group (n=19). The levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil), recovery time, length of post‑anesthesia care unit (PACU) stay, intraoperative respiratory depression, hypotension, bradycardia, as well as the incidences of postoperative dizziness, nausea and vomiting, delayed recovery and agitation were recorded in the two groups. The median effective dose (ED50) and 95% effective dose (ED95) of remimazolam during endoscopy for esophagogastric varices in cirrhosis patients were calculated by Probit regression analysis. Results The ED50 and 95% confidence interval (CI) of remimazolam during endoscopy for esophagogastric varices in cirrhosis patients were 0.105 (0.095‒0.115) mg/kg, and the ED95 and 95%CI were 0.141 (0.116‒0.166) mg/kg. There was no statistical difference in the levels of albumin, ALT, AST and TBil, recovery time, length of PACU stay, as well as the incidences of intraoperative respiratory depression, hypotension, bradycardia, postoperative dizziness, nausea and vomiting, delayed recovery and agitation between the two groups (all P>0.05). Conclusions The ED50 and ED95 values of remimazolam during endoscopy for esophagogastric varices in cirrhosis patients were 0.105 mg/kg and 0.141 mg/kg, respectively.
Key words: Remimazolam; Esophageal varices; Endoscopy; Cirrhosis; Dose‑effect relationship