【原】【罂粟摘要】芬太尼对老年女性患者瑞马唑仑诱导镇静有效剂量的影响:一项上下序贯分配试验

芬太尼对老年女性患者瑞马唑仑诱导镇静有效剂量的影响:一项上下序贯分配试验

贵州医科大学                麻醉与心脏电生理课题组

翻译：田明德             编辑：田明德   审校：曹莹

背景：本研究旨在探讨芬太尼对瑞马唑仑诱导老年女性患者全身麻醉的镇静有效剂量的影响。

方法：60名年龄在65-80岁之间接受选择性全身麻醉的女性患者被随机分为两组：RF组接受初始剂量的瑞马唑仑（7.5mg）和芬太尼（1μg/kg），而R组仅接受瑞马唑仑。根据前一位患者的反应，使用上下分配技术进行剂量调整（±2.5mg）。使用序贯公式和概率回归计算ED50和ED95。Probit回归也用于评估两组之间瑞马唑仑的相对效力。使用（MOAA/s）量表评估镇静水平。

结果：与R组相比，RF组瑞马唑仑的ED50显著降低（p=0.007）。Probit回归估计RF组的ED50和ED95值分别为4.878 mg（95%置信区间，3.845-5.859）和8.184 mg（95%置信区间，6.636-13.546）。相比之下，R组的ED50和ED95值分别为6.733mg（95%置信区间，5.533-8.068）和11.298mg（95%可信区间，9.101-19.617）。

结论：该研究提供了令人信服的证据，表明1 μg/kg芬太尼可显着减少老年患者诱导时所需的瑞玛唑仑镇静剂量约30%。重要的是，同时使用1 μg/kg芬太尼不会增加低血压、呼吸抑制等不良反应的风险。

原始文献来源：Huang XD, Chen JB, Dong XY, et al. The Impact of Fentanyl on the Effective Dose of Remimazolam-Induced Sedation in Elderly Female Patients: An Up-and-Down Sequential Allocation Trial. Drug Des Devel Ther. 2024;18:3729-3737. Published 2024 Aug 22.

The Impact of Fentanyl on the Effective Dose of Remimazolam-Induced Sedation in Elderly Female Patients: An Up-and-Down Sequential Allocation Trial

Abstract

Background: This study aimed to investigate the influence of fentanyl on the effective dose of remimazolam-induced sedation in elderly female patients undergoing general anesthesia.

Method:Sixty female patients aged 65-80 years undergoing selective general anesthesia were randomized into two groups: Group R+F received an initial dose of remimazolam (7.5 mg) with fentanyl (1 μg/kg), while Group R received remimazolam alone. Dosing adjustments (±2.5 mg) were made based on the response of the preceding patient using the up-and-down allocation technique. The ED50 and ED95 were calculated using a sequential formula and probit regression. Probit regression was also used to assess the relative potency of remimazolam between groups. Sedation levels were evaluated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale.

Results:The ED50 for remimazolam was significantly lower in Group R+F compared to Group R (p= 0.007). Probit regression estimated the ED50 and ED95 values for Group R+F at 4.878 mg (95% CI, 3.845-5.859) and 8.184 mg (95% CI, 6.636-13.546), respectively. In contrast, Group R demonstrated ED50 and ED95 values of 6.733 mg (95% CI, 5.533-8.068) and 11.298 mg (95% CI, 9.101-19.617), respectively.

Conclusion:This study provides compelling evidence that the administration of 1 μg/kg of fentanyl significantly reduces the required sedative dose of remimazolam by approximately 30% during induction in elderly patients. Importantly, the concomitant use of 1 μg/kg of fentanyl does not increase the risk of adverse effects such as hypotension, respiratory depression.