关注罂粟花，共同学习麻醉学最新文献！
瑞马唑仑与丙泊酚对经内镜逆行胰胆管造影患者血压变化的比较：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：王贵龙 编辑：田明德 审校：曹莹
背景：低血压是经内镜逆行胰胆管造影（ERCP）术中最常见的不良事件，通常归因于麻醉药物的血管舒张作用。这项随机对照试验旨在比较瑞马唑仑与丙泊酚对ERCP治疗过程中患者血压变化的影响。
方法：计划行择期ERCP治疗的成年患者随机分配接受瑞马唑仑或丙泊酚麻醉（每组40名患者）。主要指标包括诱导期间平均动脉压（MAP）的变化和整个手术过程中基线下面积（AUB：基线下血压与持续时间乘积），其分别代表麻醉诱导期间血压下降的严重程度以及整个手术过程中血压变化的总体影响。记录发生的低血压事件（MAP<65 mm Hg至少1分钟），另记录低血压恢复时间和余任何不良事件。
结果：与丙泊酚组相比，瑞马唑仑组诱导后MAP变化较小（-7.5 [-14.0至0]mm Hg VS-25.0[-33.8至-14.3]mm Hg），中位数差异为17.0 mm Hg（95%CI，12.0-22.0；P<0.001）。瑞马唑仑组的AUB低于丙泊酚组（-373[-82至-854]mm Hg* min- VS -705[-272至-1100]mm Hg*min），中位数差异为255 mm Hg*分钟（95%CI，29-477；P=0.021）。瑞马唑仑组的低血压发生率明显低于丙泊酚组（5%VS30%；P=0.006）。两组均未出现严重不良事件。
结论：瑞马唑仑可成为ERCP手术期间丙泊酚全身麻醉的替代药物，其具有稳定血流动力学的潜在优势。
原始文献来源： Yan-Ying, Xiao; Hai-Ding, Zou; Xiu-Nan, Qin; Rong, Zhu; Ru-Ping, Dai；A Comparison of Remimazolam versus Propofol on Blood Pressure Changes During Therapeutic Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial；Anesth Analg 2024 Oct 25
A Comparison of Remimazolam versus Propofol on Blood Pressure Changes During Therapeutic Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial
BACKGROUND: Intraoperative hypotension is the most common adverse event in endoscopic retrograde cholangiopancreatography (ERCP) and is usually attributed to the vasodilatory effect of the anesthetic. The aim of this randomized controlled trial was to evaluate the impact of remimazolam versus propofol on blood pressure changes during the therapeutic ERCP procedure.
METHODS:Adult patients scheduled for elective therapeutic ERCP were randomized to receive either remimazolam or propofol anesthesia (40 patients in each group). The primary outcomes included the change in mean arterial pressure (MAP) during induction and the area under the baseline (AUB), calculated as the blood pressure below baseline multiplied by the duration, throughout the procedure. These measures, respectively, indicated the severity of blood pressure decrease during anesthesia induction and the overall impact of blood pressure changes throughout the procedure. Any incidences of hypotension, defined as MAP <65 mm Hg for at least 1 minute, were recorded. The recovery time and any adverse events were also reported.
RESULTS: The change in MAP after induction was smaller in the remimazolam group compared to the propofol group (-7.5 [-14.0 to 0] mm Hg vs -25.0 [-33.8 to -14.3] mm Hg), with a median difference of 17.0 mm Hg (95% confidence interval [CI], 12.0-22.0; P <.001). The AUB in the remimazolam group was less than in the propofol group (-373 [-82 to -854] mm Hg*min vs -705 [-272 to -1100] mm Hg*min), with a median difference of 255 mm Hg*min (95% CI, 29-477; P =.021). The incidence of hypotension was significantly lower for remimazolam than propofol (5% vs 30%; P =.006). There were no serious adverse events in either group.
CONCLUSIONS: Remimazolam may be considered as an alternative to propofol for general anesthesia during therapeutic ERCP procedures, with the potential advantage of stable hemodynamics.
