瑞马唑仑联合瑞芬太尼对老年无痛纤维支气管镜检查患者的镇静效果及血流动力学影响研究

目的 观察瑞马唑仑联合瑞芬太尼对老年无痛纤支镜检查患者的临床效果，并分析其对镇静深度和血流动力学的影响。方法 选取86例从2022年1月到2023年6月在江西省胸科医院接受无痛纤维支气管镜检查的老年患者为研究对象，采用抽签法随机分为A组和B组。两组患者入组后均开放静脉鼻导管给氧，对给予2%的利多卡因，让患者屏住呼吸进行呛咳以充分扩散到气管内达到局部麻醉效果，同时两组患者给予瑞芬太尼作为基础镇痛。在此基础上，A组注射瑞马唑仑，B组注射丙泊酚。记录两组患者在麻醉诱导前（T1）、麻醉诱导后（T2）、纤支镜通过声门时（T3）、纤支镜完全置入时（T4）、完成检查时（T5）的血流动力学指标平均动脉压（mean arterial pressure，MAP）、脉搏血氧饱和度（pulse oximetry，SpO2）和心率（heart rate，HR）]和Ramsay镇静评分；并比较两组患者镇静起效时间、苏醒时间、呼吸抑制次数、不良反应及发生率和两组患者的镇静效果满意度。结果 在T3、T4、T5时刻A组的的MAP和HR明显低于B组（P<0.05）；而SPO2和Ramsay镇静评分明显高于B组（P<0.05）。组别间重复测量方差分析及不同苏醒时间测量均有统计学差异（P<0.05）；与B组相比，A组镇静起效时间、苏醒时间均明显缩短和呼吸抑制次数较少，差异有统计学意义（P<0.05）。A组不良反应发生率明显低于B组，差异有统计学意义（P<0.05）。结论 瑞马唑仑联合瑞芬太尼在复合表面局部麻醉的无痛纤支镜检查对于老年患者来说，具有更高效的镇静效果，血流动力学较稳定，不良反应发生率更低。

Effects of midazolam combined with remifentanil in elderly patients undergoing painless bronchoscopy

Objective To observe the clinical effect of remazolam combined with remifentanil on elderly patients undergoing painless fiberscopy, and to analyze its effect on the depth of sedation and hemodynamics. Methods Eighty-six elderly patients who underwent painless fiberscopy in Jiangxi Provincial Chest Hospital from January 2022 to June 2023 were selected as study subjects and divided into group A and group B according to the randomized lottery method. After enrollment, both groups of patients were opened to intravenous nasal catheter for oxygen administration, and 2% lidocaine was given to the patients, so that the patients held their breath for choking in order to fully diffuse into the trachea to achieve local anesthesia effect, and at the same time, remifentanil was given to the patients in both groups as the basic analgesia. On this basis, group A was injected with remazolam and group B was injected with propofol. The hemodynamic indexes mean arterial pressure (MAP), pulse oximetry (SpO2) and heart rate (HR)] and Ramsay sedation scores of the two groups were recorded before anesthesia induction (T1), after anesthesia induction (T2), at the time of the passage of the fiberscope through the vocal folds (T3), at the time of the complete insertion of the fiberscope (T4), at the time of completing the examination (T5). And the onset time of sedation was compared between the two groups, awakening time, number of respiratory depression, adverse reactions and incidence, and satisfaction with the sedation effect in the two groups. Results The MAP and HR of group A were significantly lower than those of group B at T3, T4 and T5 (P<0.05). While the SPO2 and Ramsay sedation score were significantly higher than those of group B (P<0.05). The repeated measures ANOVA and different awakening time measurements were statistically different between groups (P<0.05). Compared with group B, group A had a significantly shorter sedation onset time and awakening time and fewer respiratory depression, which was statistically significant (P<0.05). Group A had a statistically significant lower incidence rate of adverse reactions than group B (P<0.05). Conclusion Remazolam combined with remifentanil in compound surface local anesthesia for painless ciliopathy has more efficient sedation effect, more stable hemodynamics, and lower incidence of adverse reactions for elderly patients, and it is a potential drug that can be a safer and more efficient.