SEDline镇静监测下瑞马唑仑静脉麻醉联合胸椎旁神经阻滞在胸腔镜肺叶切除术中的应用  

Application of remimazolam toluene sulfonate combined with paravertebral nerve block in thoracoscopic lobectomy under SEDline monitoring

作　　者：李芷依 凌云志[1] 洪海宁 孙宜云 高兴悦 谢亚琼 Li Zhiyi;Ling Yunzhi;Hong Haining;Sun Yiyun;Gao Xingyue;Xie Yaqiong(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Graduate School of Bengbu Medical College,Bengbu 233030,China;Department of Thoracic Surgery,the First Affiliated Hospital of Bengbu Medical College Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院麻醉科,蚌埠233004 [2]蚌埠医学院研究生院,蚌埠233030 [3]蚌埠医学院第一附属医院胸外科,蚌埠233004

出　　处：《中华解剖与临床杂志》2023年第4期262-268,共7页Chinese Journal of Anatomy and Clinics

基　　金：安徽高校自然科学研究项目(KJ2021A0705);蚌埠医学院研究生科研创新计划项目(Byycxz21107)。

摘　　要：目的探讨在SEDline镇静监测仪监测下甲苯磺酸瑞马唑仑复合胸椎旁神经阻滞(TPVB)在胸腔镜肺叶切除术中的临床应用效果。方法前瞻性随机对照研究。纳入2021年6月—2022年5月蚌埠医学院第一附属医院择期行胸腔镜下肺叶切除术患者80例,其中男45例、女35例,年龄40~71岁。80例患者采用数字表法随机分为4组,其中采用甲苯磺酸瑞马唑仑静脉麻醉联合TPVB为TR组,采用甲苯磺酸瑞马唑仑静脉麻醉为R组,采用丙泊酚静脉麻醉联合TPVB为TB组,采用丙泊酚静脉麻醉为B组,每组20例。患者均在SEDline镇静监测仪监测下行胸腔镜肺叶切除术,术中根据患者大脑状态指数(PSI)调控麻醉药用量,PSI维持在25~50。观察指标:(1)比较4组患者性别、年龄、体质量指数(BMI)、术前血清同型半胱氨酸(Hcy)、术前简易精神状态检查量表(MMSE)认知功能评分等临床基线资料;(2)记录对比4组患者麻醉诱导前(T_(0))、切皮时(T_(1))、单肺通气30 min(T_(2))、术毕即刻(T_(3))的血氧饱和度(SPO_(2))、心率、平均动脉压(MAP),以及血清丙二醛(MDA)、晚期氧化蛋白产物(AOPP)水平;(3)记录对比4组患者手术时间、术中输液量、出血量和盐酸瑞芬太尼用量;(4)对比术后6、24 h疼痛VAS评分和Ramsay镇静评分,术后24 h血清Hcy水平、MMSE评分、镇痛泵按压次数。结果(1)4组患者性别、年龄、BMI、术前Hcy、术前MMSE评分等临床基线资料比较,差异均无统计学意义(P值均>0.05)。(2)组内比较:R组心率不同时间点差异有统计学意义(F=3.30,P=0.025),TR组、TB组、B组心率在不同时间点差异均无统计学意义(P值均>0.05);各组中的MAP、SPO_(2)、MDA、AOPP不同时间点差异均有统计学意义(P值均<0.05)。组间比较:在T_(0),4组间MAP、心率、SPO_(2)、MDA、AOPP差异均无统计学意义(P值均>0.05)。在T_(1)、T_(2),心率、MDA、AOPP差异均有统计学意义(P值均<0.05),其中TB组心率均最低,TR组MDA、AObjective This study aimed to explore the clinical value of remimzolam mesylate combined with thoracic paravertebral nerve block(TPVB)in thoracoscopic lobectomy under the monitoring of a SEDline sedation monitor.Methods A prospective randomized control study was conducted from June 2021 to May 2022.Eighty patients(45 males and 35 females,aged 40-71 years)who underwent thoracoscopic lobectomy in the First Affiliated Hospital of Bengbu Medical College were included.The patients were randomly divided into four groups by using the numerical table method.Among them,remimazolam mesylate intravenous anesthesia combined with TPVB was used as the TR group,remimazolam mesylate intravenous anesthesia was the R group,propofol intravenous anesthesia combined with TPVB was TB group,and propofol intravenous anesthesia was the B group,with 20 patients in each group.All patients underwent thoracoscopic lobectomy under the monitoring of a SEDline sedation monitor.During the operation,the anesthesia dosage was adjusted according to the patient's brain state index(PSI),which was maintained at 25-50.The observation indices were as follows.(1)The clinical baseline data of the four groups,including gender,age,body mass index(BMI),preoperative serum homocysteine(Hcy),and preoperative cognitive function score of the Mini Mental State Examination(MMSE)were compared.(2)Percutaneous arterial oxygen saturation(SPO_(2)),heart rate,mean arterial pressure(MAP),serum malondialdehyde(MDA),and advanced oxidation protein product(AOPP)were recorded and compared before anesthesia induction(T_(0)),at skin incision(T_(1)),after 30 min of one lung ventilation(T_(2)),and immediately after operation(T_(3))in the four groups.(3)The operation time,intraoperative infusion volume,bleeding volume,and remifentanil hydrochloride dosage of the four groups were recorded and compared.(4)The visual analog scale(VAS)score of pain and Ramsay sedation score at 6 and 24 h after operation were compared,and the serum Hcy level,MMSE cognitive function score,and times of pr

关 键 词：神经传导阻滞 胸椎旁神经阻滞 甲苯磺酸瑞马唑仑 SEDline监测 胸腔镜肺叶切除术 

分 类 号：R614[医药卫生—麻醉学]