丙泊酚与苯磺酸瑞马唑仑在择期行无痛纤维支气管镜活检术患者血流动力学及苏醒质量的比较

Effects of propofol and remimazolam besylate on hemodynamics and recovery quality in patients undergoing painless fiberoptic bronchoscopy

摘要:

目的 探讨丙泊酚与苯磺酸瑞马唑仑应用于无痛纤维支气管镜活检术的临床价值。方法 选取2020年1月—2022年12月什邡市人民医院拟接受无痛纤维支气管镜活检治疗的60例患者，采用随机数字表法分为丙泊酚组（P组）和苯磺酸瑞马唑仑组（R组），每组30例。对比两组患者血流动力学指标变化趋势、麻醉效果指标、苏醒期质量指标、血糖和乳酸水平变化以及麻醉不良反应的差异。结果 R组苏醒时间短于P组（P <0.05）。两组患者麻醉起效时间、苏醒后达离室标准时间比较，差异均无统计学意义（P >0.05）。两组患者麻醉前、内镜检查开始时、开始后3 min、苏醒时的心率（HR）、血氧饱和度（SpO₂）、平均动脉压（MAP）比较，结果 ①不同时间点的HR、SpO₂、MAP比较，差异均有统计学意义（P <0.05）；②两组患者MAP比较，差异有统计学意义（P <0.05），两组患者HR、SpO₂比较，差异均无统计学意义（P >0.05）；③两组患者MAP变化趋势比较，差异有统计学意义（P <0.05），两组患者HR、SpO₂变化趋势比较，差异均无统计学意义（P >0.05）。两组患者麻醉效果分级比较，差异无统计学意义（P >0.05）。两组患者不同时间点Ramsay评分比较，结果 ①不同时间点间Ramsay评分比较，差异有统计学意义（P <0.05）；②两组患者Ramsay评分比较，差异无统计学意义（P >0.05）；③两组患者Ramsay评分变化趋势比较，差异无统计学意义（P >0.05）。两组患者术前、术后即刻、术后4 h血糖、乳酸比较，结果 ①不同时间点血糖、乳酸比较，差异均有统计学意义（P <0.05）；②两组患者血糖、乳酸比较，差异均无统计学意义（P >0.05）；③两组患者血糖、乳酸变化趋势比较，差异均无统计学意义（P >0.05）。R组不良反应发生率低于P组（P <0.05）。结论 苯磺酸瑞马唑仑应用于无痛纤维支气管镜活检术较丙泊酚能更有利于血流动力学的稳定，可缩短苏醒时间，减少麻醉不良反应。

Abstract:

Objective To explore the clinical values of propofol and remimazolam besylate in painless fiberoptic bronchoscopy.Methods Sixty patients who were scheduled to receive painless fiberoptic bronchoscopy in Shifang People's Hospital from January 2020 to December 2022 were selected, and were divided into the propofol group (P group) and the remimazolam besylate group (R group) by the random number table method, with 30 patients in each group. The change trends of hemodynamic parameters, indicators of anesthetic effects and recovery quality, levels of blood glucose and lactate, and anesthesia-related adverse events were compared between the two groups.Results The postoperative recovery time of the R group was shorter than that of the P group (P < 0.05). There was no significant difference between the R group and the P group in the anesthetic onset time and the time to leave the recovery room (P > 0.05). The HR, SpO₂, and MAP at T₀, T₁, T₂ and T₃ in the two groups were compared, and the results revealed that all these indicators were different among the time points (P < 0.05) and that the MAP (P < 0.05) rather than HR and SpO₂ (P >0.05) was different between the two groups. The change trend of MAP (P < 0.05) but not that of HR and that of SpO₂ (P >0.05) was different between the two groups. There was no significant difference in the anesthetic effects between the two groups (P > 0.05). Comparison of the Ramsay scores at different time points in the two groups demonstrated that they were different among the time points (P < 0.05) but not between the groups (P > 0.05), and that the change trends of the Ramsay scores were not different between the two groups (P > 0.05). The levels of blood glucose and lactate before surgery, immediately after surgery and 4 hours after surgery in the two groups were compared, which showed that they were different among the time points (P <0.05) but not between the two groups (P > 0.05), and that the change trends of the levels of blood glucose and lactate were not different between the two groups (P > 0.05). The incidence of adverse events in the R group was lower than that in the P group (P < 0.05).Conclusion Compared with propofol, remimazolam besylate is more conducive to hemodynamic stability in patients undergoing painless fiberoptic bronchoscopy, and shortens the recovery time while reducing the incidence of anesthesia-related adverse events.