METHODS: A total of 262 American Society of Anesthesiologists Physical Status I or II patients, aged 18-65 years, scheduled for gastrointestinal endoscopy with sedation, were randomly allocated into two groups (n = 131 each): the remimazolam tosilate group (Group R) and the propofol group (Group P). Patients in Group R received 0.2-0.25 mg/Kg remimazolam tosilate intravenously, while those in Group P received 1.5-2.0 mg/kg propofol intravenously. The gastrointestinal endoscopy was performed when the Modified Observer\'s Assessment of Alertness/Sedation scores were ≤3. The primary endpoints included the endoscopic intestinal peristalsis rating by the endoscopist; serum motilin and gastrin levels at fasting without gastrointestinal preparation (T0), before gastrointestinal endoscopy (T1), and before leaving the Post Anesthesia Care Unit (T2); and the incidences of abdominal distension during Post Anesthesia Care Unit.
RESULTS: Compared with Group P, intestinal peristalsis rating was higher in Group R (P < .001); Group R showed increased motilin and gastrin levels at T2 compared with Group P (P < .01). There was a rise in motilin and gastrin levels at T1 and T2 compared with T0 and at T2 compared with T1 in both groups (P < .01). The incidence of abdominal distension was lower in Group R (P < .05).
CONCLUSIONS: Compared with propofol used during gastrointestinal endoscopy with sedation, remimazolam tosilate mildly inhibits the serum motilin and gastrin levels, potentially facilitating the recovery of gastrointestinal motility.
方法:总共262名美国麻醉医师协会体格状态I或II的患者,18-65岁,计划进行胃肠内窥镜检查并进行镇静,随机分为两组(每组n=131):甲苯磺酸瑞米唑仑组(R组)和异丙酚组(P组)。R组患者静脉内接受0.2-0.25mg/Kg甲苯磺酸瑞咪唑安定,而P组患者静脉注射丙泊酚1.5~2.0mg/kg.当改良观察者的警觉/镇静评估评分≤3时,进行胃肠内镜检查。主要终点包括内镜医师的内镜肠蠕动评分;空腹时无胃肠道准备(T0)的血清胃动素和胃泌素水平,胃肠内镜检查前(T1),以及离开麻醉后护理室(T2)之前;以及麻醉后护理室期间腹胀的发生率。
结果:与P组相比,R组的肠蠕动评分较高(P<.001);与P组相比,R组T2时胃动素和胃泌素水平升高(P<.01)。两组在T1和T2时胃动素和胃泌素水平均高于T0,在T2时高于T1(P<0.01)。R组腹胀发生率较低(P<0.05)。
结论:与在胃肠镜检查过程中使用丙泊酚镇静相比,甲苯磺酸瑞米唑仑轻度抑制血清胃动素和胃泌素水平,可能促进胃肠蠕动的恢复。