目的 观察环泊酚协同瑞马唑仑在无痛胃肠镜检查中的麻醉治疗效果及探索其合适的应用剂量。方法 选取2024年2月—2024年12月在我院接受无痛胃肠镜检查的受试者800例,采用随机数字法分为对照组和A1~A3组,每组各200例。对照组采用瑞马唑仑（0.3 mg/kg）进行麻醉诱导,A1、A2、A3组分别采用0.20、0.25、0.30 mg/kg环泊酚联合瑞马唑仑（0.15 mg/kg）麻醉诱导,对比四组的麻醉诱导时长、胃肠镜检时长、苏醒时长、定向力复原时间、心率、血压、血氧饱度、不良反应发生率。结果 A2组镇静成功率明显高于对照组和A1组（P<0.05）,与A3组无明显差异（P>0.05）;A2组胃镜检查时长明显短于对照组和A1组（P<0.05）,与A3组无明显差异（P>0.05）;A2苏醒时长和定向力复原时间均明显短于对照组和A3组（P<0.05）,与A1组无明显差异（P<0.05）。四组心率在诱导开始到睫毛反射反应消失时（T1）、胃肠镜检查开始时（T2）较预麻醉开始前5 min（T0）均明显降低（P<0.05）,且A2组心率降低幅度均明显低于对照组、A1组和A3组（P<0.05）,A3组手术结束时（T3）心率明显低于对照组、A1组和A2组（P<0.05）,对照组、A1组、A2组间均无明显差异（P>0.05）;四组T1、T2血压均较T0明显降低（P<0.05）,且A2组血压降低幅度均明显低于A1组和A3组（P<0.05）,A3组T3血压均明显低于对照组、A1组和A2组（P<0.05）,对照组、A1组、A2组间均无明显差异（P>0.05）;四组T1、T2血氧饱和度均较T0明显降低（P<0.05）,A3组血氧饱和度降低幅度均明显高于对照组、A1组和A2组（P<0.05）,A3组T3血氧饱和度均明显低于对照组、A1组、A2组（P<0.05）,对照组、A1组、A2组间均无明显差异（P>0.05）。A2组的不良反应总发生率为10.00%,明显低于对照组的21.00%、A1组的12.00%及A3组的13.00%（χ²=11.408,P<0.05）。结论 环泊酚0.25 mg/kg联合瑞马唑仑0.15 mg/kg应用于无痛胃肠镜检查中可发挥与高剂量时相同的镇静效果,有利于维持患者生命体征稳定,且不会对其呼吸造成较大影响,同时可减少不良反应的发生。

Objective To investigate the anesthetic therapeutic effect of ciprofol combined with remimazolam in painless gastroscopy and to explore its approperiate dose. Methods This study selected 800 patients who received painless gastroscopy in our hospital from February 2024 to December 2024. They were randomly divided into a control group and groups A1, A2, and A3, with 200 patients in each group. The control group patients were induced with remimazolam anesthesia （0.3 mg/kg）, Groups A1, A2, and A3 were induced with 0.20, 0.25, and 0.30 mg/kg ciprofol combined with 0.15 mg/kg remimazolam anethesia. Comparisons were conducted on the anesthesia induction time, gastrointestinal endoscopy duration, awakening time, directional force recovery time, heart rate, blood pressure, blood oxygen saturation, and incidence of adverse reactions. Results The success rate of sedation in Group A2 was significantly higher than that in the control group and Group A1 （P<0.05）, and there was no significant difference compared to Group A3 （P>0.05）. The duration of gastrointestinal endoscopy in Group A2 was significantly shorter than that in the control group and Group A1 （P<0.05）, and there was no significant difference compared to Group A3 （P>0.05）. The awakening time and directional force recovery time in Group A2 were significantly shorter than those in the control group and Group A3 （P<0.05）, and there was no significant difference compared to Group A1 （P<0.05）. The heart rates at loss of ciliary reflex after induction of anesthesia （T1） and at the begining of gastrointestinal endoscopy （T2） of the four groups of patients were all significantly reduced compared to 5 min before pre-anethesia （T0） （P<0.05）, and the decrease in heart rate in Group A2 was significantly lower than those in the control group, Group A1, and Group A3 （P<0.05）. The heart rate in Group A3 at the end of surgery （T3） was significantly lower than those in the control group, Group A1, and Group A2 （P<0.05）, while there was no significant difference between the control group, Group A1, and Group A2 （P>0.05）. The blood pressure values at T1 and T2 of the four groups of patients were significantly lower than those at T0 （P<0.05）, and the decrease in blood pressure in Group A2 was significantly lower than those in Groups A1 and A3 （P<0.05）. The blood pressure in Group A3 at T3 was significantly lower than those in the control group, Group A1, and Group A2 （P<0.05）, and there was no significant difference between the control group, Group A1, and Group A2 （P>0.05）. The blood oxygen saturation levels at T1 and T2 of the four groups of patients were significantly reduced compared to T0 （P<0.05）. The decrease in blood oxygen saturation level in Group A3 was significantly higher than those in the control group, Group A1, and Group A2 （P<0.05）. The blood oxygen saturation level at T3 in Group A3 was significantly lower than those in the control group, Group A1, and Group A2 （P<0.05）, while there was no significant difference between the control group, Group A1, and Group A2 （P>0.05）. The incidence of adverse reactions in Group A2 （10.00%） was significantly lower than those in the control group （21.00%）, Group A1 （12.00%）, and Group A3 （13.00%） （χ²=11.408, P<0.05）. Conclusion The combination of 0.25 mg/kg ciprofol and 0.15 mg/kg remimazolam in painless gastroscopy can exert the same sedative effect of ciprofol at high doses, which is beneficial for maintaining stable vital signs of patients without causing significant impact on their breathing, while reducing the occurrence of adverse reactions.