丙泊酚与瑞马唑仑用于无痛胃肠镜麻醉的研究现状

Research Status of Propofol and Remazolam for Painless Gastroenteroscopy Anesthesia

摘要: 电子消化内镜是如今消化内科最常用的临床诊疗方法。常规胃肠镜检查操作刺激较大，可能引起患者不适。丙泊酚作为一种高脂溶性的γ-氨基丁酸受体激动剂，是目前应用最广泛的临床静脉麻醉药之一，其起效快、消除快、苏醒期更平稳且苏醒后恢复更完全。除此之外，丙泊酚还可能具有止吐作用、器官及神经保护作用，并可能具有调节免疫功能的作用。但丙泊酚静脉注射时注射痛明显，许多患者术中可能会出现体动反应。静脉注射丙泊酚也可能引起低血压、心动过缓、呼吸抑制等一系列不良反应。丙泊酚用于无痛胃肠镜麻醉的健康成年人麻醉诱导剂量可为1.5~2.5 mg/kg，也可将丙泊酚与镇痛药物联合使用来缓解注射痛。麻醉维持可以通过连续输注(4~12 mg/kg/min)或根据患者反应间歇注射(0.5 mg/kg)来完成。丙泊酚在无痛胃肠镜麻醉中是一种非常有前途的镇静药。瑞马唑仑是一种苯二氮䓬类γ-氨基丁酸A型受体激动剂，其长时间使用也不会在体内大量蓄积，可用于肝肾功能不全的患者。瑞马唑仑具有起效快、镇静效果强、恢复时间短，同时不会引起明显的呼吸循环抑制的优势，且拥有拮抗剂氟马西尼。此外，瑞马唑仑还被证明具有心肺功能保护作用、脑神经保护作用及肝脏保护作用，也可能还具有一定的抗炎作用。在临床上，瑞马唑仑最常见的不良反应是低血压和呼吸抑制，其他常见的不良反应也包括呃逆、苏醒后头痛、头晕和嗜睡，且术中患者容易出现不自主体动。药物说明书推荐给予瑞马唑仑诱导剂量为0.1~0.3 mg/kg，每次追加瑞马唑仑0.05~0.10 mg/kg，且每15 min时间段内追加次数推荐不超过5次。瑞马唑仑在无痛胃肠镜麻醉领域具有很好的应用前景，是值得推广使用的镇静药物。

Abstract: Electronic digestive endoscopy is the most commonly used clinical diagnosis and treatment method in gastroenterology. Routine gastroenteroscopy is highly irritating and may cause discomfort to patients. As a high fat soluble γ-aminobutyric acid receptor agonist, propofol is currently one of the most widely used clinical intravenous anesthetics, with rapid onset, rapid elimination, more stable recovery period and more complete recovery after recovery. In addition, propofol may also have antiemetic effects, organ and neuroprotective effects, and may have a role in regulating immune function. However, the injection pain is obvious during intravenous propofol injection, and many patients may have somatokinetic reactions during the operation. Intravenous propofol may also cause a series of adverse reactions such as hypotension, bradycardia and respiratory depression. The anesthetic induction dose of propofol for painless gastroenteroscopy in healthy adults can be 1.5 to 2.5 mg/kg, or propofol can be used in combination with analgesic drugs to relieve injection pain. Maintenance of anesthesia can be accomplished by continuous infusion (4~12 mg/kg/min) or intermittent injection (0.5 mg/kg) depending on the patient’s response. Propofol is a promising sedative in painless gastroenteroscopy anesthesia. Remazolam is a benzodiazepine γ-aminobutyric acid type A receptor agonist, which does not accumulate in the body for a long time, and can be used in patients with liver and kidney dysfunction. Remazolam has the advantages of rapid onset, strong sedative effect, short recovery time, and does not cause obvious respiratory and circulatory inhibition, and has the antagonist Flumazenil. In addition, remazolam has also been shown to have cardiopulmonary, neuroprotective, and liver protective effects, and may also have some anti-inflammatory effects. Clinically, the most common side effects of remazolam are hypotension and respiratory depression. Other common side effects also include hiccup, headache after recovery, dizziness, and drowsiness, and patients are prone to involuntary movement during surgery. The drug instructions recommend that the induction dose of remazolam be 0.1~0.3 mg/kg, and the addition of remazolam is 0.05~0.10 mg/kg each time, and the addition times are recommended not to exceed 5 times every 15 minutes. Remazolam has a good application prospect in the field of painless gastroenteroscopy anesthesia and is a sedative drug worth promoting.