瑞马唑仑用于经皮穿刺椎体后凸成形术患者围术期镇静的效果  

Perioperative sedative effect of remimazolam in patients undergoing percutaneous kyphoplasty

作　　者：肖兴鹏[1] 张小亚 杨璐 琚冰雁 张红艳 郑岚[1] 李思琦 张蕾[1] XIAO Xingpeng;ZHANG Xiaoya;YANG Lu;JU Bingyan;ZHANG Hongyan;ZHENG Lan;LI Siqi;ZHANG Lei(Department of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院麻醉科,430060 [2]武汉市江夏区中医院麻醉科

出　　处：《临床麻醉学杂志》2022年第9期916-919,共4页Journal of Clinical Anesthesiology

基　　金：湖北省自然科学基金面上项目(2020CFB705)。

摘　　要：目的探讨瑞马唑仑应用于经皮穿刺椎体后凸成形术(PKP)患者围术期镇静的效果。方法选择行PKP患者80例,男39例,女41例,年龄60~80岁,BMI 18~24 kg/m 2,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:瑞马唑仑组(RM组)和右美托咪定组(DM组),每组40例。两组依次缓慢静脉注射氟比洛芬酯1 mg/kg、舒芬太尼0.2μg/kg后,RM组静脉输注瑞马唑仑0.2 mg/kg,DM组静脉输注右美托咪定0.3μg/kg,输注时间均为10 min,待两组Ramsay评分为3分时,调整药物的输注速度持续镇静(RM组:0.3~0.5 mg·kg^(-1)·h^(-1);DM组:0.20~0.75μg·kg^(-1)·h^(-1)),术中镇静深度保持Ramsay评分为3~5分,BIS 60~80。记录镇静用药前(T_(0))、局麻开始时(T_(1))、骨水泥注入时(T_(2))、苏醒时(T_(3))及苏醒后30 min(T_(4))的Ramsay评分和BIS。记录镇静起效时间、苏醒时间和术中知晓的发生情况。结果与T_(0)时比较,T_(1)、T_(2)时RM组Ramsay评分及BIS均明显降低(P<0.05),T_(1)、T_(4)时DM组Ramsay评分及BIS均明显降低(P<0.05)。与DM组比较,T_(3)、T_(4)时RM组Ramsay评分明显降低、BIS明显升高(P<0.05),RM组镇静起效时间和苏醒时间均明显缩短(P<0.05),RM组术中知晓发生率明显降低(P<0.05)。结论瑞马唑仑或右美托咪定用于PKP患者,术中均能获得良好的镇静效果且对患者呼吸及循环功能影响较小。与使用右美托咪定的患者比较,使用瑞马唑仑的患者镇静起效时间和苏醒时间明显缩短、术中知晓发生率明显降低,术后苏醒质量明显提升。Objective To investigate the perioperative sedative effect of remimazolam in percutaneous kyphoplasty(PKP)patients during surgery and after recovery.Methods Eighty patients,including 39 males and 41 females,aged 60-80 years,BMI 18-24 kg/m 2,ASA physical statusⅡorⅢ,scheduled for elective PKP,were randomly divided into two groups:remimazolam group(group RM)and dexmedetomidine group(group DM),40 patents in each group.The patients in the two groups were intravenously injected with flurbiprofen axetil 1 mg/kg and sufentanil 0.2μg/kg,then the patients in group RM were infused with remimazolam 0.2 mg/kg,and the patients in group DM were infused with dexmedetomidine 0.3μg/kg.The expected infusion time for both groups was 10 minutes.When the Ramsay score was 3 points,the infusion speed of the drug was adjusted for continue sedation(group RM:0.3-0.5 mg·kg^(-1)·h^(-1);group DM:0.20-0.75μg·kg^(-1)·h^(-1)),and the intraoperative sedation depth was maintained with Ramsay score of 3-5 points and BIS value of 60-80.The changes of Ramsay score and bispectral index(BIS)were recorded before sedation(T_(0)),at the local anesthesia(T_(1)),at the bone cement injection(T_(2)),at the time of awakening(T_(3)),and at the half an hour after awakening(T_(4)).Other index were recorded including the sedation onset time,wake-up time and cases of intraoperative awareness.Results Compared with T_(0),the Ramsay score and BIS value in group RM were significantly decreased at T_(1)-T_(2)(P<0.05),and the Ramsay sedation score and BIS value in group DM were significantly decreased at T_(1)-T_(4)(P<0.05).Compared with group DM,the Ramsay score was significantly decreased and the BIS value was significantly increased in group RM at T_(3)-T_(4)(P<0.05).The sedation onset time and wake-up time in group RM were significantly shortened(P<0.05),and the incidence of intraoperative awareness in group RM was significantly reduced(P<0.05).Conclusion In the sedation scheme of PKP surgery,both remimazolam and dexmedetomidine can achieve good intraopera

关 键 词：瑞马唑仑 右美托咪定 经皮穿刺椎体后凸成形术 镇静 

分 类 号：R614[医药卫生—麻醉学]