| 王宇浪,葛艳萍,王艳飞,等.改良序贯试验测定肥胖病人无痛胃镜检查在中度镇静水平复合瑞芬太尼时瑞马唑仑的半数有效剂量[J].安徽医药,2025,29(9):1878-1879. |
| 改良序贯试验测定肥胖病人无痛胃镜检查在中度镇静水平复合瑞芬太尼时瑞马唑仑的半数有效剂量 |
| Median effective dose of remimazolam combined with remifentanil for moderate sedation during gastroscopy in obese patients measured by improved sequential testing |
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| DOI：10.3969/j.issn.1009-6469.2025.09.038 |
| 中文关键词: 瑞马唑仑 麻醉，静脉 肥胖 胃镜检查 中度镇静 半数有效剂量 |
| 英文关键词: Remimazolam Anesthesia,intravenous Obesity Gastroscopy Moderate sedation Median effective dose |
| 基金项目:徐州医科大学附属医院睢宁分院医学科技创新项目( SRYKT202302) |
| 作者 | 单位 | E-mail | | 王宇浪 | 徐州医科大学附属医院麻醉科,江苏徐州221002
徐州医科大学麻醉学院,江苏徐州 221004 | | | 葛艳萍 | 徐州医科大学附属医院睢宁分院麻醉科,江苏徐州 221200 | | | 王艳飞 | 徐州医科大学附属医院麻醉科,江苏徐州221002
徐州医科大学麻醉学院,江苏徐州 221004 | | | 庞轩 | 徐州医科大学附属医院麻醉科,江苏徐州221002
徐州医科大学麻醉学院,江苏徐州 221004 | | | 王龙江 | 徐州医科大学附属医院麻醉科,江苏徐州221002
徐州医科大学麻醉学院,江苏徐州 221004 | | | 贾梦醒 | 徐州医科大学附属医院麻醉科,江苏徐州221002 | xzmu_jiamengxing@126.com |
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| 中文摘要: |
| 目的测定肥胖病人无痛胃镜检查在中度镇静水平复合瑞芬太尼时瑞马唑仑的半数有效剂量( ED50)。方法选择 2023年 4―6月在徐州医科大学附属医院行无痛胃镜检查肥胖病人 32例，年龄范围 18～65岁，身体质量指数( BMI)≥30 kg/m2，美国麻醉医师协会( ASA)分级 Ⅰ~Ⅱ级。监测病人生命体征，所有病人根据校正体质量给予瑞芬太尼 1 μg/kg复合瑞马唑仑初始剂量 0.08 mg/kg静脉麻醉，采用改良 Dixon序贯法进行试验，瑞马唑仑的增减剂量梯度为 0.01 mg/kg。若病人在进镜及胃镜检查中改良警觉 /镇静评分(MOAA/S)评分 >2分，处于中度镇静水平能配合言语指令做出深呼吸、睁眼等反应为阳性，下一例病人增加一个剂量梯度；反之病人在进镜及胃镜检查过程中 MOAA/S评分 ≤2分达到深度镇静水平为阴性，下一例病人减少一个剂量梯度，重复此过程，直至出现第 7次“阳性 -阴性”转折时终止研究。采用 Probit回归分析法计算瑞马唑仑的 ED50及其 95%置信区间( CI)。同时记录病人麻醉期间低氧( 75%2<90%，<60s)以及不良反应的发生情况、苏醒后不适反应的发生情况。结果 32例病人均完成检查，复合瑞芬太尼时瑞马唑仑用于肥胖病人胃镜检查中度镇静的 ED50为 0.071 mg/kg，95%CI:(0.03， 0.12)mg/kg。麻醉期间发生 7例低氧血症、 3例低血压，苏醒后出现 1例恶心呕吐、 5例头晕。结论复合瑞芬太尼时瑞马唑仑用于肥胖病人胃镜检查中度镇静的 ED50为 0.071 mg/kg，可为肥胖病人在中度镇静下行无痛胃镜检查的用药提供临床参考。 |
| 英文摘要: |
| Objective To determine the median effective dose (ED50) of remimazolam when combined with remifentanil for moderate sedation during gastroscopy in obese patients.Methods Thirty-two obese patients, undergoing painless gastroscopy in The AffiliatedHospital of Xuzhou Medical University from April to June, 2023, aged 18-65 years, with BMI≥30 kg/m2, and American Society of Anes-thesiologists (ASA) grade Ⅰ-Ⅱ, were enrolled. The vital signs of patients were monitored. All patients were given remifentanil 1 μg/kgin combination with remimazolam at an initial dose of 0.08 mg/kg for intravenous anesthesia according to the adjusted body weight. Thetest was carried out using the modified Dixon's up-and-down method, and each time the dose was increased or decreased by 0.01 mg/kgbased on the sedative effect. The response was defined as positive when the patient's score of modified observer's assessment of alert-ness/sedation (MOAA/S)>2 during the process of endoscopic insertion and gastroscopy procedure and the patient was at moderate seda-tion and can cooperate with verbal instructions such as taking deep breathes, opening eyes. If the patient responded positively, the doseof remimazolam increased by 0.01 mg/kg in the next patient. Conversely, if the patient's score of MOAA/S was no greater than 2 and thepatient was at deep sedation, defined as negative, the dose of remimazolam decreased by 0.01 mg/kg in the next patient. This processwas repeated until the seventh "positive-negative" transition occurred, at which point the study was terminated. The ED50 and 95% con-fidence interval (CI) of remimazolam were calculated by Probit regression analysis. Simultaneously we recorded the occurrence of hy-poxia (75%2<90%, <60 s) and adverse reactions during anesthesia, as well as the occurrence of discomfort reactions after awaken-ing.Results All patients completed the gastroscopy examination, the ED50 of remimazolam combined with remifentanil for moderate sedation during gastroscopy in obese patients was 0.071 mg/kg, 95%CI:(0.03, 0.12) mg/kg. During anesthesia, 7 cases of hypoxemiaand 3 cases of hypotension occurred, followed by 1 case of nausea and vomiting and 5 cases of dizziness after awakening.Conclusion The ED50 of remimazolam combined with remifentanil for moderate sedation during gastroscopy in obese patients was 0.071 mg/kg,which can provide clinical reference for the medication of painless gastroscopy examination in obese patients under moderate sedation. |
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