不同剂量瑞马唑仑复合环泊酚在肝门部胆管癌超声内镜检查细针抽吸活检中的应用效果比较

Effects of different doses of remimazolam combined with ciprofol on endoscopic ultrasound-guided fine needle aspiration for hilar cholangiocarcinoma

摘要:

目的 探讨不同剂量瑞马唑仑复合环泊酚在肝门部胆管癌（CCA）超声内镜检查细针抽吸活检（EUS-FNA）中效果。方法 选取2021年3月—2024年3月上海中医药大学附属龙华医院收治120例因CCA行EUS-FNA的患者作为研究对象。随机将患者分为A、B1、B2、B3共4组，每组30例。A组静脉注射环泊酚0.6 mg/kg；B1组、B2组、B3组先分别静脉注射瑞马唑仑0.1、0.2和0.3 mg/kg，随后静脉注射环泊酚0.4 mg/kg。记录患者麻醉情况、术中术后不良反应情况及满意度。结果 B2组、B3组镇静成功率高于B1组（P <0.006 25）。B1组、B2组、B3组环泊酚用量均低于A组（P <0.05），B2组、B3组环泊酚用量均低于B1组（P <0.05）。4组细针抽吸活检时间比较，差异无统计学意义（P >0.05）。B1组、B2组、B3组苏醒及离院时间均短于A组（P <0.05），B3组苏醒时间及离院时间均长于B1组、B2组（P <0.05）。B1组术中呛咳、体动发生率均高于B3组（P <0.006 25），A组低氧血症发生率高于B2组（P <0.006 25）。4组患者满意度比较，差异无统计学意义（P >0.05）。B1组、B3组内镜医师满意率低于A组（P <0.006 25），B2组、B3组内镜医师满意率低于B1组（P <0.006 25），B3组内镜医师满意度低于B2组（P <0.006 25）。结论 中剂量（0.2 mg/kg）瑞马唑仑与环泊酚复合使用镇静成功率较高，且较安全，最适合用于CCA患者EUS-FNA。

Abstract:

Objective To investigate the effect of different doses of remimazolam combined with ciprofol on endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for hilar cholangiocarcinoma (CCA).Methods A total of 120 patients with CCA who underwent EUS-FNA from March 2021 to March 2024 in our hospital were selected. They were randomly divided into A, B1, B2, and B3 groups, with 30 cases in each group. Group A received intravenous injection of 0.6 mg/kg ciprofol, while groups B1, B2, and B3 received intravenous injection of remimazolam at doses of 0.1, 0.2, and 0.3 mg/kg, respectively, followed by intravenous injection of ciprofol at a dose of 0.4 mg/kg. The anesthesia conditions, intraoperative and postoperative adverse reactions, and satisfaction were recorded.Results The success rate of sedation in groups B2 and B3 was higher than that in group B1 (P < 0.006 25). The dosage of ciprofol in groups B1, B2 and B3 was lower than that in group A (P < 0.05), and the dosage of ciprofol in groups B2 and B3 was lower than that in group B1 (P < 0.05). There was no significant difference in the time of the FNA procedure among the four groups (P > 0.05). The recovery time and discharge time of groups B1, B2 and B3 were shorter than those of group A (P < 0.05), and the recovery time and discharge time of group B3 were longer than those of groups B1 and B2 (P < 0.05). The incidences of cough and body movement in group B1 were higher than those in group B3 (P < 0.006 25), and the incidence of hypoxemia in group A was higher than that in group B2 (P < 0.006 25). The satisfaction rate of endoscopists in groups B1 and B3 was lower than that in group A (P < 0.006 25), the satisfaction rate of endoscopists in groups B2 and B3 was lower than that in group B1 (P < 0.006 25), and the satisfaction rate of endoscopists in group B3 was lower than that in group B2 (P < 0.006 25).Conclusions Moderate-dose (0.2 mg/kg) remimazolam combined with ciprofol has a higher success rate of sedation and a reliable safety profile, making it the most suitable option for EUS-FNA in patients with CCA.