| 粟国炜,严敏.复合阿芬太尼时瑞马唑仑抑制纤维支气管镜置入时心血管反应的有效剂量[J].浙江中西医结合杂志,2024,34(7): |
| 复合阿芬太尼时瑞马唑仑抑制纤维支气管镜置入时心血管反应的有效剂量 |
| The Effective Dosage of Remimazolam Combined with Alfentanil for Suppressing Cardiovascular Response during Fibreoptic Bronchoscopy Intubation. |
| 投稿时间：2024-03-23 修订日期：2024-06-23 |
| DOI： |
| 中文关键词: 瑞马唑仑 纤维支气管镜 心血管反应 有效剂量 |
| 英文关键词:Remimazolam,Fibreoptic Bronchoscopy,Cardiovascular Response,Effective Dosage |
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| 中文摘要: |
| 目的 探讨瑞马唑仑复合阿芬太尼抑制纤维支气管镜置入时心血管反应的有效剂量。方法 选择行无痛纤维支气管镜检查的患者40例,年龄18-65岁,瑞马唑仑初始剂量为0.2mg/kg,所有患者在诱导剂量瑞马唑仑给药结束后30s内给予10ug/kg阿芬太尼,麻醉医生评估MOAA/S＜1后开始纤支镜检查。瑞马唑仑剂量按偏倚95％硬币的序贯设计。心血管反应阳性定义为纤支镜开始进镜至过隆突后2分钟内的血压和心率变化幅度≥基础值的20%,且持续时间大于1分钟。95%有效剂量(ED95)及95％CI使用Probit回归分析和自举法(Bootstrap)得出。结果 瑞马唑仑复合10ug/kg阿芬太尼抑制纤维支气管镜置入时心血管反应的ED95为0.393mg/kg(95% CI：0.381–0.432 mg/kg),所有的患者在给予首次瑞马唑仑剂量后都能达到MOAA/S＜1并开始纤支镜检查,33例(82.5%)患者检查过程顺利,未出现心血管反应。7例(17.5%)患者在检查中出现缺氧,经过提高氧流量和托下颌处理后迅速恢复。结论 瑞马唑仑复合10ug/kg阿芬太尼抑制纤维支气管镜置入时心血管反应的ED95为0.393mg/kg(95% CI：0.381–0.432 mg/kg)。 |
| 英文摘要: |
| Objective To investigate the effective dose of remimazolam combined with alfentanil in suppressing cardiovascular responses during the insertion of a fiberoptic bronchoscope. Methods Forty patients undergoing painless fiberoptic bronchoscopy were selected, aged 18-65 years, with a BMI of 18-28 kg/m^2, and classified as ASAⅠor Ⅱ. The initial patient received 0.2 mg/kg of remimazolam, and all patients were administered alfentanil at 10 ug/kg within 30 seconds after the preset dose of remimazolam. The examination began when the anesthesiologist assessed MOAA/S < 1. The dosage of remimazolam was adjusted using a biased-coin design sequential method.A positive cardiovascular response was defined as an increase in blood pressure and heart rate by ≥20% of the baseline value within 2 minutes after the insertion of the fiberoptic bronchoscope and lasting more than one minute. The ED95 and 95% CI were determined using Probit regression analysis and the Bootstrap method. Results The ED95 for remimazolam combined with 10 ug/kg alfentanil in suppressing cardiovascular responses during fiberoptic bronchoscope insertion was 0.393 mg/kg, with a 95% CI of 0.381–0.432 mg/kg. All patients achieved MOAA/S < 1 after the initial dose of remimazolam and commenced the bronchoscopic examination; 7 patients (17.5%) experienced hypoxia during the procedure, which was promptly resolved by increasing oxygen flow and jaw thrust. Conclusion The ED95 for remimazolam combined with 10 ug/kg alfentanil in suppressing cardiovascular responses during fiberoptic bronchoscope insertion is 0.393 mg/kg (95% CI: 0.381–0.432 mg/kg). |
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