2025 年第 2 期 第 20 卷

复合瑞马唑仑时地佐辛抑制老年女性患者宫腔镜手术改良鼻咽通气道置入反应的半数有效剂量研究

Study on the median effective dose of dezocine to inhibit the response to modified nasopharyngeal airway insertion during hysteroscopic surgery in elderly female patients when combined with remimazolam

作者：包音1王古岩1张丛雅1王影1李凯博2王惠军1

英文作者：Bao Yin1 Wang Guyan1 Zhang Congya1 Wang Ying1 Li Kaibo2 Wang Huijun1

单位：1首都医科大学附属北京同仁医院麻醉科，北京100730；2首都医科大学，北京100069

英文单位：1Department of Anesthesiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China; 2Capital Medical University Beijing 100069 China

关键词：地佐辛；半数有效剂量；瑞马唑仑；改良鼻咽通气道；宫腔镜手术

英文关键词：Dezocine;Medianeffectivedose;Remimazolam;Modifiednasopharyngealairway;Hysteroscopicsurgery

• 摘要：

• 目的 探讨复合瑞马唑仑时地佐辛抑制老年女性患者宫腔镜手术改良鼻咽通气道置入反应的半数有效剂量(ED50)。方法 选择2024年2—4月首都医科大学附属北京同仁医院择期行宫腔镜手术患者28例，年龄60～75岁，美国麻醉医师协会分级Ⅱ～Ⅲ级。患者注射地佐辛0.15 mg/kg，10 min后依次静脉注射阿托品0.3 mg，地塞米松5 mg，瑞马唑仑0.3 mg/kg，待患者睫毛反射消失，患者状态指数＜50时，经鼻腔插入充分润滑的改良型鼻咽通气道。采用序贯法确定下一例患者地佐辛的剂量，若置入鼻咽通气道时出现阳性反应，则下一例患者地佐辛的用量升高0.01 mg/kg，否则降低0.01 mg/kg，把出现鼻咽通气道阳性反应的前一例患者作为进入试验的第1例患者，重复此过程，直到出现7个转折点后停止。计算复合瑞马唑仑时地佐辛抑制老年患者改良鼻咽通气道置入反应的ED50及95%置信区间。记录诱导过程中不良反应发生情况。结果 1例患者因插入鼻咽通气道后通气不良，术中改为喉罩通气，剔除本试验。余27例患者完成了试验，复合瑞马唑仑时地佐辛抑制改良鼻咽通气道置入反应的ED50(95%置信区间)为0.105(0.087～0.114)mg/kg。入选患者均未出现鼻咽痛、低氧血症、嗜睡、恶心呕吐、呼吸抑制等不良反应。1例患者拔管后出现一过性头晕，在恢复室经充分苏醒后好转。结论 老年女性患者宫腔镜手术中复合0.3 mg/kg瑞马唑仑时，地佐辛抑制改良鼻咽通气道置入反应的ED50(95%置信区间)为0.105(0.087～0.114)mg/kg。

• Objective To investigate the median effective dose(ED50) of dezocine to inhibit the response to modified nasopharyngeal airway insertion during hysteroscopic surgery in elderly female patients when combined with remimazolam. Methods Twenty-eight patients, aged 60-75 years, American Society of Anesthesiologists grade Ⅱ-Ⅲ, scheduled for elective hysteroscopic surgery in Beijing Tongren Hospital, Capital Medical University from February to April 2024, were selected. Dezocine 0.15 mg/kg was injected, and 10 minutes later atropine 0.3 mg, dexamethasone 5 mg and remimazolam 0.3 mg/kg were injected intravenously. When the eyelash reflex disappeared and the patient′s state index was less than 50, a fully lubricated modified nasopharyngeal airway was inserted through the nasal cavity. The dose of dezocine in the next patient was determined by sequential method. If there was a positive reaction when the nasopharyngeal airway was inserted, the dose of dezocine in the next patient was increased by 0.01 mg/kg, otherwise the dose of dezocine was decreased by 0.01 mg/kg. The first patient with a positive nasopharyngeal airway reaction was considered the first patient to enter the trial, and this process was repeated until seven turning points had been reached. The ED50 and 95% confidence interval of dezocine inhibiting response to modified nasopharyngeal airway insertion in elderly patients were calculated when combined with remimazolam. The occurrence of adverse reactions during induction was recorded. Results One patient was excluded from this study because of poor ventilation after insertion of the nasopharyngeal airway, which was changed to laryngeal mask airway during the operation. The remaining 27 patients completed the trial, and the ED50(95% confidence interval) of dezocine inhibiting response to modified nasopharyngeal airway insertion was 0.105(0.087-0.114)mg/kg when combined with remimazolam.No adverse reactions such as nasopharyngeal pain, hypoxemia, drowsiness, nausea and vomiting, and respiratory depression occurred in the enrolled patients. One patient had transient dizziness after extubation and recovered after full recovery in the recovery room. Conclusion When combined with 0.3 mg/kg remimazolam, the ED50(95% confidence interval) of dezocine inhibiting the modified nasopharyngeal airway insertion response is 0.105(0.087-0.114)mg/kg in elderly female patients during hysteroscopic surgery.