不同剂量瑞马唑仑联合阿芬太尼在儿童无痛胃镜中的应用.

Objective: To explore the application effect of different doses of remifentanil combined with remifentanil in painless gastroscopy in children. Methods: 165 pediatric patients who underwent painless gastroscopy from May 2023 to November 2023 were selected as the study subjects. They were randomly divided into four groups using a random number table method, namely R1 (n=40), R2 (n=40), R3 group (n=40), and Matched group (n=45). Patients in the Matched group were intravenously injected with 2 mg/kg propofol and 7% fentany l μg/kg, R1, R2, R3 groups intravenous injection of fentanyl 7 μg/kg and Remazolam, R1 group Remazolam is 0.2 mg/kg. The R2 group is 0.3 mg/kg, and the R3 group is 0.4 mg/kg. Gastroscopy should be performed when all patients have improved alertness/calmness (MOAA/S) scores ≤ 1. Compare the success rate of sedation, onset time of sedation, awakening time, gastroscopy examination time, and number of times of remedial sedation among four groups of children. Evaluate the degree of sedation using MOAA/S scores before administration, after initial administration, before endoscopy, and immediately after examination. Record the changes in heart rate, blood pressure, oxygen saturation, heart rate (HR), and blood oxygen saturation (SpO2) of the four groups of children before anesthesia induction (T0), at entry (T1), and after anesthesia induction (T2), Finally, compare the incidence of adverse reactions among the four groups of children. Results: There was no difference in the recovery time and gastroscopy examination time among the four groups of patients(P>0.05). The success rate of sedation in the R3 group was higher than that in the R1 group, R2 group, and Matched group. The onset time of sedation and the number of times of remedial sedation were lower than those in the R1 group, R2 group, and Matched group (P<0.05); There was no difference in MOAA/S scores among the four groups of patients before administration and immediately after examination(P>0.05). After the first administration and before endoscopy, the MOAA/S scores of R3 group patients were lower than those of R1 group, R2 group, and Matched group (P<0.05); There was no change in blood oxygen saturation (SpO2) levels and heart rate (HR) levels at T0, T1, and T2 time in the four groups of patients, and there was no difference between the four groups(P>0.05). The HR levels of patients in the T2 and R3 groups were stable, but there were fluctuations between the R1 and R2 groups and the Matched group. The T1 and R3 group was lower than the R1 and R2 groups and the Matched group (P<0.05); The incidence of adverse reactions such as injection pain, laryngeal spasm, hypoxemia, hypotension, and bradycardia in patients in R1, R2, and R3 groups was lower than that in the Matched group (P<0.05), but there was no difference in the comparison of R1, R2, and R3 groups(P>0.05). Conclusion: The combination of Remazolam and Alfentanil can improve the sedative effect during gastroscopy in children, and Remazolam at a dose of 0.4 mg/kg is more effective. It can further improve the success rate of sedation, reduce the number of times of remedial sedation, and do not increase the awakening time. The sedative effect is better, and it can stabilize the heart rate level during the examination of children, with higher safety. [ABSTRACT FROM AUTHOR]