| Objective:To observe the clinical effects of remimazolam besylate combined with alfentanil on elderly patients in painless flexible bronchoscopy.Methods:A total of 45 patients who underwent flexible bronchoscopy in the Second Department of Respiratory Surgery of the Second Hospital of Hebei Medical University from October 2020 to January 2021 were enrolled and randomly divided into two groups:group RA（n=23）and group MA（n=22）.Prednisone 40mg and penehyclidine hydrochloride 0.01mg·kg-1 were given preoperatively.Remimazolam besylate combined with alfentanil was used in group RA,while midazolam combined with alfentanil was used in group MA for anesthesia.MOAA/S score was maintained at 2～4 and flumazenil was given postoperatively.General data of patients in two groups were recorded.The success rate of sedation,the dosages of remimazolam besylate,midazolam,alfentanil,1%lidocaine and 1:50000 epinephrine administered by endoscopic physicians,the amount of liquid infusion,examination time,recovery time and vital signs at different time points in two groups were recorded.Incidence of intraoperative adverse events,interventions,and postoperative adverse reactions were recorded.Patients’satisfaction,degree of forgetting,willingness to reexamine if necessary,and endoscopist’s satisfaction were evaluated.Results:1.There were no statistical differences in gender,age,height,weight,BMI,preoperative complications,modified Mallampati grade,NYHA heart function classification,ASA grade and the types of flexible bronchoscopy between the two groups（P>0.05）.2.The success rate of sedation in group RA was 91.3%,and there was no statistical difference compared with group MA,which was 90.9%（P>0.05）.3.Remimazolam besylate was 17.0±7.4mg in group RA and midazolam was 4.1±0.7mg in group MA.There were no significant differences between two groups in the dosages of alfentanil,1%lidocaine,1:50000 adrenaline given by the endoscopist and liquid infusion（P>0.05）.Patients in both groups reached the leaving room standard within 3min.Compared with group MA,there was no statistical difference in the examination time and recovery time in group RA.4.Compared with T0,MAP in both groups showed a downward trend within the normal range from T1 to T6,with significant differences statistically（P<0.05）.Compared with T0,HR,SpO2 and RR in group RA and group MA fluctuated from T1 to T6,but the difference was not statistically significant（P>0.05）.Compared with group MA,there were no significant differences in MAP,HR,SpO2 and RR at different time points from T0 to T6 in group RA（P>0.05）.5.There was no significant difference in adverse events and intervention measures between the two groups during the examination（P>0.05）.The higher incidence of adverse events in group RA and group MA were hypertension（17.4%vs.27.3%,P=0.491）and tachycardia（21.7%vs.22.7%,P=1.000）.6.There was no statistical difference in the incidence of postoperative adverse reactions between the two groups（P>0.05）.The higher incidence of postoperative adverse reactions in group RA and group MA were dizziness（17.4%vs.22.7%,P=0.722）and drowsiness（13.0%vs.22.7%,P=0.459）.7.There was no bad memory of the diagnosis and treatment process between two groups,and there was no significant difference in the satisfaction of patients（P>0.05）.Compared with group MA,the patients in group RA were more willing to be examined again if necessary,and the satisfaction of the endoscopist was higher,but the differences were not statistically significant（P>0.05）.Conclusions:Under the premise of the application of flumazenil postoperatively,remimazolam besylate combined with alfentanil in flexible bronchoscopy showed reliable anesthesia effects and high safety,which can provide similar anesthetic effects with midazolam combined with alfentanil.Both of them have the characteristics of rapid postoperative recovery,less adverse reactions,and high satisfaction of patients and endoscopists. |
