瑞马唑仑联合瑞芬太尼在泌尿外科短小手术中的研究  

Remimazolam Combined with Remifentanil in Urological Surgery

作　　者：江漩[1] 郑小艳[1] 嵇富海[1] 毕国荣 李健[1] 朱晓刚[1] JIANG Xuan;ZHENG Xiao-yan;JI Fu-hai;BI Guo-rong;LI Jian;ZHU Xiao-gang(Department of Anesthesiology,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院麻醉科,江苏苏州215006

出　　处：《中国药学杂志》2021年第22期1840-1843,共4页Chinese Pharmaceutical Journal

摘　　要：目的本试验旨在探讨不同剂量瑞马唑仑联合瑞芬太尼在泌尿外科短小手术中的安全性和有效性。方法75例患者,根据麻醉诱导剂量不同分为3组,A组:瑞马唑仑0.2 mg·kg^(-1),B组:瑞马唑仑0.3 mg·kg^(-1),C组:瑞马唑仑0.4 mg·kg^(-1)。同时记录脑电双频指数(bispect ral index,BIS),待BIS值降至60以下,各组均静脉依次缓慢推注舒芬太尼注射液0.2μg·kg^(-1)及司可林1 mg·kg^(-1),1 min后置入喉罩。A、B、C组置入喉罩前患者如出现BIS>60,则予以追加瑞马唑仑0.05 mg·kg^(-1)至患者BIS值≤60,如3次追加后仍BIS值>60则视为诱导失败,并追加丙泊酚。麻醉维持:A、B、C各组瑞马唑仑起始泵注剂量为1~2 mg·kg^(-1)·h^(-1),各组均同时泵注瑞芬太尼0.25~0.5μg·kg^(-1)·min^(-1),术中根据患者有无流泪、出汗、血流动力学情况以及BIS值调节各药物的泵注速度。待手术结束时停止所有药物。术中观察:不同剂量瑞马唑仑的诱导镇静成功率;全麻诱导时从给药到患者BIS≤60的时间;全麻诱导及维持过程中的BIS及不良反应情况;全麻诱导及维持过程中的补救镇静药物;苏醒时间;在离开苏醒室以及术后24 h,评估所有患者是否有术中知晓发生;评估术后患者的恢复质量。结果A组的单次诱导成功率为76%,B、C 2组的单次诱导成功率为100%。随着诱导剂量的增加,BIS≤60的时间缩短。术中A、B组低血压的发生率为4%,C组低血压的发生率为8%。诱导过程中置入喉罩前A、B组低氧血症的发生率为4%,C组低氧血症的发生率为12%。各组均顺利完成了全麻诱导和维持,未见术中知晓的发生。术后恢复质量高,且各组之间未见明显统计学差异。结论瑞马唑仑联合瑞芬太尼用于泌尿外科手术是安全可行且有效的,0.3 mg·kg^(-1)诱导剂量并且1 mg·kg^(-1)·h^(-1)维持剂量对患者血流动力学影响不大,术后恢复质量较高。OBJECTIVE To investigate the safety and efficacy of different doses of remimazolam combined with remifentanil in urological short operation.METHODS Seventy-five patients who underwent elective microsomia urology surgery in our hospital were divided into 3 groups according to different induced dose of anesthesia:group A:remazolam 0.2 mg·kg^(-1),group B:remazolam 0.3 mg·kg^(-1)group C:remazolam 0.4 mg·kg^(-1).At the same time,the bispect ral index(BIS)was recorded.When the BIS value was lower than 60,sufentanil 0.2μg·kg^(-1)and Scholin 1 mg·kg^(-1)were injected successively in each group,and the laryngeal mask was placed 1min later.If BIS>60 after the initial dose of remimazolam,they were given 0,05 mg·kg^(-1)remimazolam,up to a maximum of three supplemental doses administered as IV boluses,was permitted after 1 min at the end of the initial dose.If BIS was still>60 after 3 times of addition,the induction failure was considered,and propofol was added.Anesthesia maintenance:remimazolam was administered at a dose of 1 mg·kg^(-1)·h^(-1)and adjusted as appropriate(maximum allowed infusion rate:2 mg·kg^(-1)·h^(-1))based on BIS value and monitoring of the general condition of individual subjects until the end of the surgery.Stop all medications at the end of the operation.Intraoperative observation:the success rate of induced sedation with different doses of remimazolam;the time from administration to BIS≤60 during general anesthesia induction;changes of BIS and intraoperative adverse reactions were recorded during induction and maintenance of general anesthesia;remedic sedatives during induction and maintenance of general anesthesia;recovery time;Intraoperative recall was assessed which was administered 24 h after surgery and before the patient left the recovery room.RESULTS The success rate of single induction was 76%in group A and 100%in group B and C.With the increase of induced dose,the time of BIS≤60 was shortened.The incidence of intraoperative hypotension in group A and B was 4%,and that in group C

关 键 词：瑞马唑仑 瑞芬太尼 全身麻醉 泌尿外科 

分 类 号：R95[医药卫生—药学]