【罂粟摘要】无阿片类药物异丙酚或瑞马唑仑麻醉对胃肠内窥镜检查中肥胖患者低氧血症发生率的影响：一项前瞻性、随机临床试验

无阿片类药物异丙酚或瑞马唑仑麻醉对胃肠内窥镜检查中肥胖患者低氧血症发生率的影响：一项前瞻性、随机临床试验

贵州医科大学   麻醉与心脏电生理课题组

翻译：文春雷   编辑：柏雪   审校：曹莹

背景：目前对肥胖患者进行胃肠道内窥镜检查的最佳镇静策略尚无共识。本研究旨在探讨无阿片类药物异丙酚或瑞马唑仑平衡麻醉对肥胖患者低氧血症发生率的影响。

方法：共264例患者随机分为瑞马唑仑+艾司氯胺酮组（R组）和异丙酚+艾司氯胺酮组（P组）。P组采用异丙酚、艾司氯胺酮麻醉，R组采用瑞马唑仑、艾氯胺酮麻醉。主要结果是低氧血症的发生率。次要结果是意识丧失（LoC）和恢复的时间，以及术中和术后不良反应的发生率。

结果：我们发现R组轻度低氧血症的发生率与P组相似（14.2% vs. 11.5%，p = 0.396）。R组严重低氧血症的发生率明显低于P组（4.2% vs. 9.2%，p = 0.019）。R组发生LoC的时间比P组长[中位数（四分位数范围，IQR)：53 s（45至61）vs. 50 s（42至54），p = 0.001]。R组麻醉恢复的时间小于P组[中位（IQR）：48 min（41至58）vs. 55.5 min（46至67），p<0.001]。不良事件发生率差异无统计学意义（p >0.05）。

结论：我们的结论是，与异丙酚联合艾司氯胺酮相比，瑞马唑仑联合艾氯胺酮可以降低肥胖患者在胃肠道内镜检查中严重低氧血症的发生率。

原始文献来源：Keyao Zhang,Yuan Bao, Xue Han,et al.Effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity during gastrointestinal endoscopy: A prospective, randomized clinical trial.[J]. Front Med,2023,10: 1124743 .

英文原文：

Effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity during gastrointestinal endoscopy: A prospective, randomized clinical trial

There are presently no consensuses on the optimal sedation strategy for obese patients during gastrointestinal endoscopy. This study aim to explore the effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity. A total of 264 patients were randomized to remimazolam + esketamine group (group R) or propofol + esketamine group (group P). Anesthesia in group P was administrated by propofol, esketamine and in group R by remimazolam, esketamine. The primary outcome was incidence of

hypoxemia. Secondary outcomes were the time to loss of consciousness (LoC) and to recovery and the incidence of intraoperative and postoperative adverse reactions. We found the incidence of mild hypoxemia in group R was similar to that in group P (14.2% vs. 11.5%, p = 0.396). The incidence of severe hypoxemia in group R was significantly lower than Group P (4.2% vs. 9.2%, p = 0.019). The time to LoC in group R was longer than group P [Median (interquartile range, IQR):

53 s (45 to 61) vs. 50 s (42 to 54), p = 0.001]. The time to recovery from anesthesia in group R was less than group P [Median (IQR): 48 min (41 to 58) vs. 55.5 min (46 to 67), p<0.001]. There was no significant difference in the incidence of adverse events (p > 0.05 for all). We concluded that compared with propofol combined with esketamine, remimazolam combined with esketamine can reduce the incidence of severe hypoxemia during gastrointestinal endoscopy in obese patients.

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