瑞马唑仑和丙泊酚对无痛胃肠镜术后早期睡眠质量效果及应激反应的比较

Comparison of the Effects of Remimazolam and Propofol on Early Sleep Quality and Stress Response after Painless Gastrointestinal Endoscopy

摘要: 目的：探讨瑞马唑仑与丙泊酚分别联合地佐辛对无痛胃肠镜检查患者术后早期睡眠质量、应激反应及并发症的影响。方法：选取2024年6月至2024年12月台州市中西医结合医院收治的94例胃肠镜检查患者作为研究对象，采用随机数字表法分为丙泊酚组(n = 47)与瑞马唑仑组(n = 47)。两组均静脉注射地佐辛0.1 mg/kg，丙泊酚组联合丙泊酚2 mg/kg诱导麻醉，瑞马唑仑组联合瑞马唑仑0.3 mg/kg诱导麻醉。分别于术前(T0)、术后第1天(T1)、术后第3天(T2)及术后第7天(T3)采用匹兹堡睡眠质量指数(PSQI)评估患者睡眠质量；检测术前和术毕即刻的血清皮质醇(Cor)和血糖(Glu)水平以评估应激反应；并记录两组并发症发生情况。结果：1) 睡眠质量：组内比较显示，两组T1时点睡眠障碍发生率均显著高于T0 (瑞马唑仑组38.3% vs. 丙泊酚组40.4%，P < 0.05)，但T2、T3时点与T0比较差异无统计学意义(P > 0.05)。组间比较显示，两组各时点睡眠障碍发生率差异均无统计学意义(P > 0.05)。2) 应激反应：术毕即刻，瑞马唑仑组Cor及Glu水平均显著低于丙泊酚组(P < 0.05)。3) 并发症：瑞马唑仑组注射痛、低血压及低氧血症发生率均显著低于丙泊酚组(P < 0.05)。结论：瑞马唑仑联合地佐辛用于无痛胃肠镜检查，对患者术后当天睡眠质量的影响与丙泊酚相当，但能更有效地抑制围术期应激反应，并显著降低注射痛、低血压及低氧血症等麻醉相关并发症的发生风险。

Abstract: Objective: To investigate the effects of Remimazolam and Propofol combined with Dezocine on early postoperative sleep quality, stress response and complications in patients undergoing painless gastrointestinal endoscopy. Methods: From June 2024 to December 2024, 94 patients undergoing gastrointestinal endoscopy admitted to Taizhou Hospital of Integrated Traditional Chinese and Western Medicine were selected as the research objects and randomly divided into propofol group (n = 47) and remimazolam group (n = 47). Both groups received intravenous Dezocine 0.1 mg/kg. The propofol group was induced with Propofol 2 mg/kg, and the remimazolam group was induced with Remimazolam 0.3 mg/kg. The Pittsburgh Sleep Quality Index (PSQI) was used to assess patients’ sleep quality before surgery (T0), and on the 1st (T1), 3rd (T2), and 7th (T3) day after surgery. Serum cortisol (Cor) and blood glucose (Glu) levels were measured before surgery and immediately after surgery to assess stress response. The incidence of complications in both groups was recorded. Results: 1) Sleep quality: Intra-group comparison showed that the incidence of sleep disturbance at T1 in both groups was significantly higher than that at T0 (Remimazolam group 38.3% vs. Propofol group 40.4%, P < 0.05), but there was no statistically significant difference between T2, T3 and T0 (P > 0.05). There was no statistically significant difference in the incidence of sleep disturbance between the two groups at any time point (P > 0.05). 2) Stress response: Immediately after surgery, the levels of Cor and Glu in the remimazolam group were significantly lower than those in the propofol group (P < 0.05). 3) Complications: The incidence of injection pain, hypotension, and hypoxemia in the remimazolam group was significantly lower than that in the propofol group (P < 0.05). Conclusion: Remimazolam combined with Dezocine for painless gastrointestinal endoscopy has an effect on patients’ sleep quality on the day after surgery comparable to that of propofol, but it can more effectively inhibit the perioperative stress response and significantly reduce the risk of anesthesia-related complications such as injection pain, hypotension, and hypoxemia.