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瑞马唑仑与丙泊酚在老年胸腔镜肺叶切除术患者全麻诱导及维持中的效果对比
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| 篇名： | 瑞马唑仑与丙泊酚在老年胸腔镜肺叶切除术患者全麻诱导及维持中的效果对比 |
| TITLE： | Comparison of the efficacy of remimazolam and propofol in the induction and maintenance of general anesthesia in elderly patients undergoing thoracoscopic lobectomy |
| 摘要： | 目的 对比瑞马唑仑与丙泊酚在老年胸腔镜肺叶切除术患者全麻诱导及维持中的有效性与安全性。方法选择2024年2－7月在重庆大学附属三峡医院行胸腔镜肺叶切术的老年肺癌患者86例，按随机数字表法将其分为丙泊酚组和瑞马唑仑组（各43例）。麻醉诱导中，丙泊酚组和瑞马唑仑组患者分别静脉注射丙泊酚中/长链脂肪乳注射液2mg/kg或注射用甲苯磺酸瑞马唑仑0.25mg/kg；麻醉维持中，两组分别静脉泵注丙泊酚中/长链脂肪乳注射液6～10mg/（kg·h）或注射用甲苯磺酸瑞马唑仑1～3mg/（kg·h）。比较两组患者的麻醉效果、麻醉相关指标、术中阿片类药物和肌松药用量、镇静/疼痛评分、血流动力学指标，并记录不良反应发生情况。结果丙泊酚组有41例、瑞马唑仑组有43例患者完成试验。瑞马唑仑组麻醉效果Ⅰ级的患者比例显著高于丙泊酚组，而Ⅱ级患者比例显著低于丙泊酚组（P＜0.05）；该组患者的睫毛反射消失时间、脑电双频指数降至60所用时间、Ramsay镇静评分（术后2、6h时）均显著延长或升高，苏醒时间、疼痛数字分级评分（术后2、6h时）及术中低血压的发生率均显著缩短或降低，且上述镇静/疼痛评分的改善在术后2～24h内呈时间依赖性（P＜0.05）；与麻醉诱导前（T0）比较，两组患者给药后2min（T1）、给药后5min（T2）、手术开始时（T3）、麻醉后60min（T4）、手术结束时（T5）的心率[瑞马唑仑组T1、T4、T5时除外]、平均动脉压[瑞马唑仑组T1时除外]均显著降低，局部脑氧饱和度均显著升高，且瑞马唑仑组患者T1、T2、T4时的心率和平均动脉压均显著高于丙泊酚组（P＜0.05）。两组患者的麻醉后复苏室滞留时间、阿片类药物和肌松药用量、各时间点局部脑氧饱和度、外周血氧饱和度比较，差异均无统计学意义（P＞0.05）。结论相较于丙泊酚，瑞马唑仑用于老年胸腔镜肺叶切除术患者的全麻诱导及维持时，可使患者获得更佳的麻醉效果、更稳定的术中血流动力学指标、更短的苏醒时间及更低的术中低血压发生率。 |
| ABSTRACT： | OBJECTIVE To compare the clinical efficacy and safety of remimazolam and propofol in general anesthesia induction and maintenance for elderly patients undergoing thoracoscopic lobectomy. METHODS A total of 86 elderly lung cancer patients who underwent thoracoscopic lobectomy at Chongqing University Three Gorges Hospital from February to July 2024 were selected and divided into the propofol group and the remimazolam group according to the randomized numerical table method， with 43 cases in each group. During anesthesia induction， patients in the propofol group and the remimazolam group were intravenously administered 2 mg/kg of Propofol medium- and long-chain fat emulsion injection or 0.25 mg/kg of Remimazolam tosilate for injection， respectively； during anesthesia maintenance， the two groups received intravenous infusion of 6-10 mg/（kg·h） of Propofol medium- and long- chain fat emulsion injection or 1-3 mg/（kg·h） of Remimazolam tosilate for injection， respectively. The anesthesia effects， anesthesia-related indicators， intraoperative opioid and muscle relaxant dosages， Ramsay sedation score， numerical rating scale （NRS） score， and hemodynamic parameters were compared between the two groups， and the occurrence of adverse drug reactions was recorded. RESULTS A total of 41 patients in the propofol group and 43 patients in the remimazolam group completed the trial. The proportion of patients with grade Ⅰ anesthesia effect in the remimazolam group was significantly higher than that in the propofol group， while the proportion of patients with grade Ⅱ anesthesia effect was significantly lower than that in the propofol group （P＜0.05）. In this group， the disappearance time of eyelash reflex， the time taken for the bispectral index to drop to 60， and the Ramsay sedation scores （2 and 6 hours after operation） were all significantly prolonged or increased， while the recovery time， NRS scores （2 and 6 hours after operation）， and the incidence of intraoperative hypotension were all significantly shortened or reduced； moreover， the improvements of the above sedation/NRS scores exhibited a time-dependent pattern within 2 to 24 hours after operation （P＜0.05）. Compared with before anesthesia induction （T0）， the heart rate [except at 2 min after medication （T1）， 60 min after anesthesia （T4）， and at the end of surgery （T5） in the remimazolam group] and mean arterial pressure [except at T1 in the remimazolam group] of patients in both groups significantly decreased at T1， 5 min after medication （T2）， at the start of surgery （T3）， T4， and T5 （P＜0.05）. Meanwhile， regional cerebral oxygen saturation significantly increased in both groups. Furthermore， the heart rate and mean arterial pressure of patients in the remimazolam group were significantly higher than those in the propofol group at T1， T2 and T4 （P＜0.05）. No statistically significant differences were observed between the two groups in terms of postanesthesia care unit stay time， dosage of opioids and muscle relaxants， regional cerebral oxygen saturation， or peripheral oxygen saturation at various time points （P＞0.05）. CONCLUSIONS Compared to propofol， remimazolam demonstrates superior anesthesia effects when used for the induction and maintenance of general anesthesia in elderly patients undergoing thoracoscopic lobectomy. It not only provides more stable intraoperative hemodynamics and shortens the postoperative recovery time but also effectively reduces the incidence of intraoperative hypotension. |
| 期刊： | 2025年第36卷第16期 |
| 作者： | 刘春；胡娟；黄煜；阳锦秋；李俊杰；杨平；潘鹏飞 |
| AUTHORS： | LIU Chun，HU Juan，HUANG Yu，YANG Jinqiu，LI Junjie，YANG Ping，PAN Pengfei |
| 关键字： | 瑞马唑仑；丙泊酚；老年患者；胸腔镜肺叶切除术；肺癌；麻醉维持；麻醉诱导；效果 |
| KEYWORDS： | remimazolam； propofol； elderly patients； thoracoscopic lobectomy； lung cancer； anesthesia maintenance； |
| 阅读数： | 8 次 |
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