摘要
目的比较不同剂量瑞马唑仑复合舒芬太尼在全麻下腹腔镜胆囊切除术(LC)中的应用效果。方法选取2021年1月至2023年1月计划在新乡医学院第一附属医院行全麻下LC的204例患者,按照随机数字表法分为A组、B组和C组,各68例。A组接受小剂量的瑞马唑仑(0.2 mg·kg-1)复合舒芬太尼行麻醉诱导,B组接受大剂量的瑞马唑仑(0.3 mg·kg-1)复合舒芬太尼行麻醉诱导,C组接受丙泊酚(2.0 mg·kg-1)复合舒芬太尼行麻醉诱导;诱导完成后,3组均以静脉恒速输注丙泊酚复合瑞芬太尼维持麻醉,间歇性注射罗库溴铵维持肌肉松弛。观察3组患者麻醉诱导前及插管前后的血流动力学变化,比较手术时间、麻醉药物用量、麻醉诱导后/术中药物追加率;对比3组患者停药后的麻醉恢复时间(包括自主呼吸恢复时间、苏醒时间、拔管时间)、术后精神状态以及不良事件的发生情况。结果3组插管前即刻与插管后即刻的平均动脉压(MAP)低于诱导前(P<0.05),插管后即刻的MAP均高于插管前即刻(P<0.05);3组插管前即刻的心率(HR)均低于诱导前(P<0.05),3组插管后即刻的HR均高于插管前即刻(P<0.05),C组插管后即刻的HR低于诱导前(P<0.05);A组任意时刻的MAP、HR与B组比较,差异无统计学意义(P>0.05),A组、B组插管前即刻与插管后即刻的MAP、HR均高于C组(P<0.05)。3组手术时间、瑞芬太尼用量比较,差异无统计学意义(P>0.05),B组、C组丙泊酚用量均少于A组(P<0.05),B组丙泊酚用量与C组比较,差异无统计学意义(P>0.05);B组、C组药物追加率均低于A组(P<0.05),B组药物追加率与C组比较,差异无统计学意义(P>0.05)。A组自主呼吸恢复时间、苏醒时间、拔管时间与B组比较,差异无统计学意义(P>0.05),C组自主呼吸恢复时间、苏醒时间、拔管时间均长于A组、B组(P<0.05)。3组患者术后24、72 h简易精神状态检查(MMSE)评分均低于入手术室前(P<0.05),术后72 h的MMSE评分均高于术后24 h(P<0.05),但A组、B组、C组间在术后24、72 h的MMSE评分比较,差异无统计学意义(P>0.05)。A组不良事件发生率与B组对比,差异无统计学意义(P>0.05),但A组、B组不良事件总发生率均低于C组(P<0.05),且A组低血压发生率低于C组(P<0.05)。结论不同剂量瑞马唑仑复合舒芬太尼应用于全麻下LC中对患者的血流动力学、术后恢复与认知功能、安全性的影响相近,但相较于0.2 mg·kg-1瑞马唑仑,使用0.3 mg·kg-1瑞马唑仑能够减少追加麻醉药物,镇静效果更佳,值得临床推荐应用。
Objective To compare the application effect of different doses of remidazolam combined with sufentanil respectively in laparoscopic cholecystectomy(LC)under general anesthesia.Methods A total of 204 patients who planned to undergo LC under general anesthesia in the First Affiliated Hospital of Xinxiang Medical College from January 2021 to January 2023 were selected and divided into group A,group B and group C by a random number table,with 68 cases in each group.The group A was given anesthesia induction with a small dose of remidazolam(0.2 mg·kg-1)combined with sufentanil,while group B was given anesthesia induction with a large dose of remiazolam(0.3 mg·kg-1)combined with sufentanil,and group C was given anesthesia induction with propofol(2.0 mg·kg-1)combined with sufentanil.After induction,propofol combined with remifentanil was intravenous infused at a constant rate to maintain anesthesia in three groups,and rocuronium bromide was injected intermittently to maintain muscle relaxation.The hemodynamic changes of patients in the three groups before anesthesia induction and before and after intubation were observed,and the operation time,dosage of anesthetic drugs and drug addition rates after anesthesia induction/during operation were compared.The recovery time of anesthesia(including spontaneous breathing recovery time,awakening time,extubation time)after drug withdrawal,postoperative mental status and incidences of adverse events were compared among the three groups of patients.Results In the three groups,the mean arterial pressure(MAP)immediately before intubation and immediately after intubation was lower than before induction(P<0.05),and MAP immediately after intubation was higher than immediately before intubation(P<0.05).The heart rates(HR)immediately before intubation were lower than before induction in three groups(P<0.05),and the HR immediately after intubation were higher than immediately before intubation in three groups(P<0.05),and the HR immediately after intubation in group C was lower than before induction(P<0.05).There was no statistically significant difference in MAP and HR between group A and group B at any time(P>0.05),but the MAP and HR immediately before and after intubation in group A and group B were higher than group C(P<0.05).There was no difference in the operation time and remifentanil dosage among the three groups(P>0.05),but the dosage of propofol in group B and group C were less than group A(P<0.05),and there was no difference in the propofol dosage between group B and group C(P>0.05).The drug addition rates in group B and group C were lower than group A(P<0.05),but there was no difference in drug addition rates between group B and group C(P>0.05).There was no difference in the recovery time of spontaneous breathing,awakening time and extubation time between group A and group B(P>0.05),while the recovery time of spontaneous breathing,awakening time and extubation time in group C were longer than group A and group B(P<0.05).In the three groups,the mini-mental state examination(MMSE)scores of patients at 24 and 72 h after operation were lower than those before entering the operating room(P<0.05),and the MMSE scores at 72 h after operation were higher than those at 24 h after operation(P<0.05),but there was no statistically difference in the MMSE scores among the group A,group B and group C at 24 and 72 h after operation(P>0.05).There was no statistically significant difference in the incidence rates of adverse events between group A and group B(P>0.05),but the total incidence rates of adverse events in group A and group B were lower than group C(P<0.05),and the incidence rate of hypotension in group A was lower than group C(P<0.05).Conclusion Different doses of remiazolam combined with sufentanil in LC under general anesthesia have similar impact on hemodynamics,postoperative recovery,cognitive function and safety of patients.However,comparing with 0.2 mg·kg-1 remimazolam,the use of 0.3 mg·kg-1 remimazolam can reduce the additional anesthetic drugs,and the sedative effect is better,which is worthy of clinical recommendation.
作者
田建民
陈胜阳
李晓芳
刘国泽
刘俊
张永强
TIAN Jianmin;CHEN Shengyang;LI Xiaofang;LIU Guoze;LIU Jun;ZHANG Yongqiang(Department of Anesthesiology,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)
出处
《河南医学研究》
CAS
2024年第5期859-864,共6页
Henan Medical Research
