Abstract:

Objective　To study the efficacy and safety of remimazolam tosylate in anesthesia for interventional thrombectomy for patients with intracranial vascular embolism. Methods　Eighty patients with intracranial vascular embolism who underwent interventional thrombectomy at Liaocheng Third People's Hospital from October 2021 to March 2023 were selected for the randomized controlled trial, and were divided into a mazolam combined with dezocine group (R+D group) and a propofol combined with dezocine group (P+D group) by the random number table method, with 40 cases in each group. There were 23 males and 17 males in the R+D group; they were (61.7±7.4) years old. There were 21 males and 19 females in the P+D group; they were (61.5±7.6) years old. The efficacies, adverse reactions, renal function, inflammatory factors, and T lymphocytes were compared between the R+D group and the P+D group. The mean artery pressures (MAP), heart rates (HR), and blood oxygen saturations (SpO₂) were compared between the two groups after entering the room (T0), after the completion of anesthesia induction (T1), during the maintenance of anesthesia (T2), at the beginning of the operation (T3), after the operation (T4), and when they woke up after the operation (T5). The independent-sample t test and χ² test were applied. Results　The operation time, recovery time, ICU time, first feeding time, time to get out of bed, and incidences of hypotension, respiratory depression, and intraoperative body movement reaction in the R+D group were all lower than those in the P+D group [(67.8±9.2) min vs. (81.4±10.6) min, (16.9±4.5) min vs. (27.1±5.2) min, (2.6±0.9) d vs. (3.9±1.1) d, (1.3±0.5) d vs. (1.8±0.7) d, (3.1±0.8) d vs. (4.6±1.1) d, 12.5% (5/40) vs. 40.0% (16/40), 12.5% (4/40) vs. 37.5% (15/40), and 7.5% (3/40) vs. 35.0% (14/40)], with statistical differences (all P<0.05). The MAP, HR, and SpO₂ at T1, T2, T3, T4, and T5 in the R+D group were lower than those in the P+D group. After the treatment, the levels of hs-CRP, TNF-α, IL-6, S100B, and MBP in the R+D group were lower than those in the P+D group [(4.1±0.7) mg/L vs. (8.2±1.1) mg/L, (10.3±2.1) pg/L vs. (16.7±3.1) pg/L, (8.5±1.2) pg/L vs. (11.4±1.5) pg/L, (1.1±0.3) ng/L vs. (1.6±0.5) ng/L, and (3.7±0.8) μg/L vs. (4.6±1.1) μg/L]; the levels of CD3+, CD4+, CD8+, and Tau protein in the R+D group were higher than those in the P+D group [(59.7±3.2)% vs. (56.1±2.8)%, (29.5±1.9)% vs. (27.3±1.8)%, (17.2±1.5)% vs. (15.4±1.4)%, and (28.5±4.3) μg/L vs. (24.3±3.9) μg/L]; there were statistical differences (all P<0.05). Conclusion Remimazolam tosylate has the advantages of good sedation effect and high safety in anesthesia for interventional thrombectomy for patients with intracranial vascular embolization, and has little impact on the patients' inflammatory response and immune function.

Key words:

Intracranial vascular embolism, Interventional thrombectomy, Remimazolam tosylate, Curative effect

摘要：

目的　研究甲苯磺酸瑞马唑仑在颅内血管栓塞患者介入取栓术麻醉中的疗效及安全性。方法　选取2021年10月至2023年3月聊城市第三人民医院收治的行颅内血管栓塞行介入取栓术患者进行随机对照试验，采用随机数字表法分为甲苯磺酸瑞马唑仑联合地佐辛组（R+D组）与丙泊酚联合地佐辛组（P+D组），各40例。R+D组中，男23例，女17例，年龄（61.7±7.4）岁；P+D组中，男21例，女19例，年龄（61.5±7.6）岁。比较两组患者疗效、不良反应、肾功能、炎症因子及T淋巴细胞差异，比较两组患者入室后（T0）、麻醉诱导完成后（T1）、麻醉维持（T2）、手术开始操作时（T3）、手术结束后（T4）及术毕苏醒时（T5）患者MAP、HR及SpO₂差异。采用独立样本t检验、χ²检验进行统计分析。结果　R+D组患者手术时间、苏醒时间、ICU入住时间、首次进食时间、下床活动时间、低血压、呼吸抑制、术中体动反应等并发症发生率均低于P+D组患者［（67.8±9.2）min比（81.4±10.6）min、（16.9±4.5）min比（27.1±5.2）min、（2.6±0.9）d比（3.9±1.1）d、（1.3±0.5）d比（1.8±0.7）d、（3.1±0.8）d比（4.6±1.1）d、12.5%（5/40）比40.0%（16/40）、12.5%（5/40）比37.5%（15/40）、7.5%（3/40）比35.0%（14/40）］，差异均有统计学意义（均P<0.05）。R+D组患者T1、T2、T3、T4、T5时MAP、HR及SpO₂水平低于P+D组患者。治疗后R+D组和P+D组患者hs-CRP、TNF-ａ、IL-6、CD3+、CD4+及CD8+均高于治疗前（均P<0.05）。治疗后，R+D组患者hs-CRP、TNF-α、IL-6、S100B及MBP均低于P+D组患者［（4.1±0.7）mg/L比（8.2±1.1）mg/L、（10.3±2.1）pg/L比（16.7±3.1）pg/L、（8.5±1.2）pg/L比（11.4±1.5）pg/L、（1.1±0.3）ng/L比（1.6±0.5）ng/L、（3.7±0.8）μg/L比（4.6±1.1）μg/L］，CD3+、CD4+及CD8+、Tau蛋白高于P+D组患者［（59.7±3.2）%比（56.1±2.8）%、（29.5±1.9）%比（27.3±1.8）%、（17.2±1.5）%比（15.4±1.4）%、（28.5±4.3）μg/L比（24.3±3.9）μg/L］，差异均有统计学意义（均P<0.05）。结论　甲苯磺酸瑞马唑仑在颅内血管栓塞行介入取栓术麻醉中具有镇静效果好及安全性高等优点，对患者炎症反应及免疫功能影响少。

关键词:

颅内血管栓塞, 介入取栓术, 甲苯磺酸瑞马唑仑, 疗效