瑞马唑仑复合丙泊酚对学龄期患儿无痛胃镜检查追加情况的影响

Influence of remimazolam combined with propofol on drug supplementation during painless gastroscopy in school-age children

摘要:

目的 探讨瑞马唑仑复合丙泊酚在学龄期患儿无痛胃镜检查中的应用效果，重点分析其对药物追加情况的影响，同时评估血流动力学稳定性、临床相关指标及不良反应发生情况。方法 选取2023年6月—2025年6月在西安市儿童医院行无痛胃镜检查的150例学龄期患儿为研究对象，采用随机数字表法将其分为丙泊酚组（P组）、瑞马唑仑组（R组）、瑞马唑仑复合丙泊酚组（RP组），每组50例。P组患儿采用丙泊酚进行麻醉诱导与维持，R组患儿采用瑞马唑仑进行麻醉诱导与维持，RP组患儿采用瑞马唑仑复合丙泊酚进行麻醉诱导与维持。比较3组患儿在不同时刻［麻醉诱导前（T₀）、胃镜入镜时（T₁）、退镜结束时（T₂）、苏醒即刻（T₃）］血流动力学指标［心率（HR）、收缩压（SBP）、舒张压（DBP）］，记录并分析3组患儿的药物用量及药物追加次数，统计3组患儿的临床相关指标（麻醉起效时间、苏醒时间、胃镜检查时间），同时观察并比较3组患儿不良反应发生情况。结果 P组、R组及RP组T₀、T₁、T₂、T₃血流动力学指标比较，结果 ①不同时间点HR、SBP、DBP比较，差异有统计学意义（P <0.05）；②P组、R组、RP组HR、SBP、DBP比较，差异无统计学意义（P >0.05）；③3组HR、SBP、DBP变化趋势比较，差异无统计学意义（P >0.05）。RP组丙泊酚用量低于P组（P <0.05），RP组瑞马唑仑用量低于R组（P <0.05）。RP组药物追加次数均小于P组和R组（P <0.05）。RP组麻醉起效时间慢于P组、快于R组（P <0.05）；RP组苏醒时间短于P组和R组（P <0.05）；RP组胃镜检查时间短于P组和R组（P <0.05）。RP组低血压发生率低于R组（P <0.05），P组呃逆发生率低于R组（P <0.05）。RP组患儿发生≥2种并发症例数低于P组和R组（P <0.05）。结论 在学龄期患儿无痛胃镜检查中，瑞马唑仑复合丙泊酚麻醉可减少单一药物用量及追加次数，维持SBP稳定，缩短苏醒时间与胃镜检查时间，降低低血压等不良反应发生率，安全性与有效性优于单一用药，可作为学龄期患儿无痛胃镜检查的优选麻醉方案。

Abstract:

Objective To explore the effect of remimazolam combined with propofol in painless gastroscopy for school-age children, focusing on its influence on drug supplementation, and evaluate hemodynamic stability, clinical indicators and adverse reactions.Methods One hundred and fifty school-age children undergoing painless gastroscopy at our Hospital (June 2023 to June 2025) were divided into three groups via random number table (50 cases each): propofol group (P), remimazolam group (R), and remimazolam-propofol group (RP). P group used propofol alone for anesthesia induction and maintenance; R group used remimazolam alone; RP group used remimazolam plus propofol. Hemodynamic indicators[heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) ] were compared at T₀ (before induction), T₁ (gastroscope insertion), T₂ (end of withdrawal), T₃ (awakening). Drug dosages (propofol, remimazolam), supplementation frequency, clinical indicators (anesthesia onset time, awakening time, gastroscopy time) and adverse reactions were recorded and compared.Results Comparisons of hemodynamic parameters among Group P, Group R, and Group RP at T₀, T₁, T₂, and T₃ showed statistically significant differences in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) across different time points (P < 0.05), while the main effect between groups and interaction effect were not statistically significant (P > 0.05). The dosage of propofol in Group P was higher than that in Group RP, and the dosage of remimazolam in Group R was higher than that in Group RP (P < 0.05). The number of additional drug administrations in Group RP was lower than that in Group P and Group R (P < 0.05). The onset time of anesthesia in Group RP was longer than that in Group P (P < 0.05) but shorter than that in Group R (P < 0.05); the recovery time in Group RP was shorter than that in both Group P and Group R (P < 0.05); the duration of gastroscopy in Group RP was shorter than that in Group P and Group R (P < 0.05). The incidence of hypotension in Group RP was significantly lower than that in Group R, and the incidence of hiccups in Group P was significantly lower than that in Group R (P < 0.05). The number of children with two or more? adverse reactions in the RP group was significantly lower than that in the P group and the R group (P < 0.05).Conclusion Remimazolam combined with propofol for school-age children’s painless gastroscopy reduces single-drug dosage and supplementation frequency, maintains SBP stability, shortens awakening and gastroscopy time, and lowers adverse reaction incidence (e.g., hypotension). It is safer and more effective than single propofol or remimazolam, and serves as a preferred anesthesia scheme for such children.