瑞马唑仑对老年外科手术全身麻醉血流动力学的影响及安全性分析

doi:10.3760/cma.j.issn.1007-1245.2023.22.026

摘要/Abstract

摘要：

目的　观察瑞马唑仑对老年外科手术全身麻醉期间血流动力学的影响及用药安全性。方法　选取郑州市第七人民医院2021年1月至2023年4月收治的125例老年外科手术患者进行随机对照试验，以数字随机表法分为观察组与对照组。观察组63例，男33例，女30例，年龄（75.22±5.27）岁；对照组62例，男31例，女31例，年龄（76.13±5.33）岁。对照组术中实施常规全身麻醉，观察组采用瑞马唑仑辅助全身麻醉，比较两组患者诱导期间的麻醉镇静深度，麻醉前（T0）、诱导后（T1）、脑电双频指数（BIS）≤60（T2）、气管插管后（T3）等不同时间点下的血流动力学指标变化情况、麻醉补救情况、术后苏醒质量及麻醉相关不良反应发生情况。采用χ²检验、Fisher确切概率、t检验进行统计比较。结果　观察组诱导后BIS≤60耗时为（60.25±20.33）s、气管插管前BIS值为（58.11±10.27），均低于对照组［（76.25±20.12）s、（65.22±10.36）］，差异均有统计学意义（均P<0.05）。两组T0、T1、T2时的心率（HR）与平均动脉压（MAP）比较，差异均无统计学意义（均P>0.05）；观察组T3时的HR、MAP及T0～T3的HR、MAP差值均低于对照组，差异均有统计学意义（均P<0.05）。观察组麻醉补救率为4.76%（3/63）、麻醉补救剂量为（3.35±0.36）mg，均低于对照组［16.13%（10/62）、（8.26±2.41）mg］，差异均有统计学意义（均P<0.05）。两组患者的苏醒时间、麻醉恢复室（PACU）停留时间比较差异均无统计学意义（均P>0.05），但观察组的视觉模拟疼痛量表（VAS）评分以及镇静评分（RSS）均低于对照组，差异均有统计学意义（均P<0.05）。观察组麻醉相关不良反应发生率为7.94%（5/63），略高于对照组［6.45%（4/62）］，差异无统计学意义（P>0.05）。结论　瑞马唑仑辅助全身麻醉有利于老年外科手术患者更快达到满意麻醉深度，对维持麻醉期间血流动力学稳定并减少补救治疗均有积极意义，也未明显增强不良反应的发生风险，安全性较高。

关键词:

全身麻醉, 瑞马唑仑, 老年外科手术, 血流动力学, 麻醉安全性

Abstract:

Objective　To observe the effect of remidazolam on hemodynamics of elderly patients taking surgery under general anesthesia and its safety. Methods　One hundred and twenty-five elderly patients taking surgery at Zhengzhou Seventh People's Hospital from January 2021 to April 2023 were selected for the randomized controlled trial. They were divided into an observation group and a control group by the a random number table method, with 63 cases in each group. There were 33 males and 30 females in the observation group; they were (75.22±5.27) years old. There were 31 males and 31 females in the control group; they were (76.13±5.33) years old. The control group received routine general anesthesia during surgery, while the observation group received remimazolam assisted general anesthesia. The depths of anesthesia, sedation during induction, hemodynamic indicators before anesthesia (T0), after induction (T1), when bispectral index (BIS) ≤60 (T2), and after tracheal intubation (T3), remdedy of anesthesia, and the occurrences of anesthesia related adverse reactions were compared between the two groups. χ² test, Fisher's exact probability, and t test were applied. Results　The time for BIS getting ≤ 60 after induction and BIS before tracheal intubation in the observation group were lower than those in the control group [(60.25±20.33) s vs. (76.25±20.12) s and (58.11±10.27) vs. (65.22±10.36)], with statistical differences (both P<0.05). There were no statistical differences in heart rate (HR) and mean arterial pressure (MAP) in both groups between at T0 on one hand and at T1 and T2 on the other hand (all P>0.05). The HR and MAP at T3 and the differences of HR and MAP at T0, T1, T2, and T3 in the observation group were lower than those in the control group, with statistical differences (all P<0.05). The remedy rate and dose of the observation group were lower than those of the control group [4.76% (3/63) vs. 16.13% (10/62) and (3.35±0.36) mg vs. (8.26±2.41) mg], with statistical differences (both P<0.05). There were no statistical differences in the time for the patients to come to and the time staying the anesthesia recovery room between the two groups (P>0.05). The scores of Visual Analogue Scale and sedation in the observation group were lower than those in the control group, with statistical differences (both P<0.05). The incidence of anesthesia related adverse reactions in the observation group was slightly higher than that in the control group [7.94% (5/63) vs. 6.45% (4/62)], with no statistical difference (P>0.05). Conclusions　Remazolam assisted general anesthesia is beneficial for elderly surgical patients to achieve a satisfactory depth of anesthesia faster, and has positive significance in maintaining hemodynamic stability during anesthesia and reducing remedial treatment. Combined use of this drug does not significantly increase the risk of adverse reactions, and its safety is relatively high.

Key words:

General anesthesia, Remazolam, Elderly surgical procedures, Hemodynamics, Anesthesia safety

陈佳王俊伟.

瑞马唑仑对老年外科手术全身麻醉血流动力学的影响及安全性分析 [J]. 国际医药卫生导报, 2023, 29(22): 3254-3258.

Chen Jia, Wang Junwei.

Effect of remidazolam on hemodynamics of elderly patients taking surgery under general anesthesia and its safety [J]. International Medicine and Health Guidance News, 2023, 29(22): 3254-3258.

参考文献

[1] 张乐,刘凯东,刘铭,等.腹腔镜微创手术对老年直肠癌患者生理耐受性、生存质量及3年随访预后观察[J].川北医学院学报,2018,33(3):364-368.DOI:10.3969/j.issn.1005-3697.2018.03.018.
[2] Sioutas G, Tsoulfas G. Frailty assessment and postoperative outcomes among patients undergoing general surgery[J]. Surgeon, 2020,18(6):e55-e66. DOI: 10.1016/j.surge.2020.04.004.
[3] Du YT, Li YW, Zhao BJ, et al. Long-term survival after combined epidural-general anesthesia or general anesthesia alone: follow-up of a randomized trial[J]. Anesthesiology, 2021,135(2):233-245. DOI: 10.1097/ALN.0000000000003835.
[4] 郝珍,段浩.CSEA及全麻对老年前列腺切除术患者血流动力学参数及疼痛、认知的影响[J].医学临床研究,2023,40(2):248-251.DOI:10.3969/j.issn.1671-7171.2023. 02.025.
[5] 刘莹珠,张登文,王晟.老年患者非心脏手术围手术期心血管不良事件的危险因素[J].国际麻醉学与复苏杂志,2021,42(9):987-993.DOI:10.3760/cma.j.cn321761- 20201010- 00379.
[6] 崔家田,杨扬,邱丽,等.不同剂量瑞马唑仑麻醉诱导对瑞芬太尼抑制气管插管反应的半数有效血浆靶浓度的影响[J].临床麻醉学杂志,2022,38(12):1278-1281.DOI:10.12089/jca.2022.12.009.
[7] 谯瞧,宋平义,官彬,等.气管插管全身麻醉行腹部手术老年患者肺部感染的危险因素及预测模型构建[J].重庆医学,2022,51(7):1167-1171,1176.DOI:10.3969/j.issn.1671- 8348. 2022.07.017.
[8] Knuf KM, Manohar CM, Cummings AK. Addressing inter-rater variability in the ASA-PS classification system[J]. Mil Med, 2020,185(5-6):e545-e549. DOI: 10.1093/milmed/usz433.
[9] Lim BG, Lee IO. Anesthetic management of geriatric patients[J]. Korean J Anesthesiol, 2020,73(1):8-29. DOI: 10.4097/kja.19391.
[10] Codère-Maruyama T, Moore A. Anesthesia in the elderly patient undergoing otolaryngology head and neck surgery[J]. Clin Geriatr Med, 2018,34(2):279-288. DOI: 10.1016/j.cger.2018.01.005.
[11] 陆志强,汤英华,胥建党.PiCCO技术对老年骨折患者全身麻醉手术中血流动力学评估的作用[J].徐州医科大学学报,2021,41(1):39-44.DOI:10.3969/j.issn.2096-3882. 2021.01.009.
[12] 阿尔达克·夏买提,魏靖茹,陆天佑,等.胸腹按压对无痛胃镜患者丙泊酚镇静引起呼吸抑制的预防[J].中山大学学报(医学科学版),2022,43(4):631-638.DOI:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).202205.
[13] 王东,彭彤,贺建刚,等.依托咪酯联合丙泊酚靶控输注全麻对老年手术患者血流动力学及肾上腺皮质功能的影响[J].老年医学与保健,2020,26(3):432-435.DOI:10.3969/j.issn.1008-8296.2020.03.026.
[14] Lee A, Shirley M. Remimazolam: a review in procedural sedation[J]. Drugs, 2021,81(10):1193-1201. DOI: 10.1007/s40265-021-01544-8.
[15] 刘爱芬,卢悦淳.瑞马唑仑优势分析及在麻醉领域应用进展[J].沈阳药科大学学报,2022,39(7):893-898.DOI:10.14066/j.cnki.cn21-1349/r.2021.0679.
[16] 段怡,王晓宇,高志峰,等.瑞马唑仑用于老年患者椎管内麻醉程序性镇静的半数有效剂量[J].临床麻醉学杂志,2023,39(1):34-38.DOI:10.12089/jca.2023.01.007.
[17] 杨成迪,徐海龙,李健,等.瑞马唑仑与丙泊酚全麻诱导对颈动脉内膜剥脱术老年患者脑氧饱和度及脑血流的影响[J].沈阳药科大学学报,2022,39(12):1515-1520.DOI:10.14066/j.cnki.cn21-1349/r.2022.0061.
[18] 李陆军,张绍刚,曹雪莲,等.BIS监测应用于七氟醚吸入全身麻醉对老年腹腔镜胆囊切除术患者苏醒质量、应激反应和认知功能的影响[J].现代生物医学进展,2022,22(17):3289-3293.DOI:10.13241/j.cnki.pmb.2022.17.017.
[19] 江漩,郑小艳,嵇富海,等.瑞马唑仑联合瑞芬太尼在泌尿外科短小手术中的研究[J].中国药学杂志,2021,56(22):1840-1843.DOI:10.11669/cpj.2021.22.010.
[20] 贾涛,刘辉,滕金亮.瑞马唑仑的药理特点、安全性及联合用药研究进展[J].中国药房,2023,34(8):1020-1024.DOI:10.6039/j.issn.1001-0408.2023.08.24.