机构地区:[1]郑州大学第一附属医院心血管外科,河南郑州450052 [2]郑州大学第一附属医院麻醉与围术期医学部,河南郑州450052 [3]河南中医药大学第五临床医学院,河南郑州450000
出 处:《中华实用诊断与治疗杂志》2023年第4期422-425,共4页Journal of Chinese Practical Diagnosis and Therapy
基 金:河南省高等学校重点科研项目计划(20A320060)。
摘 要:目的探讨行二尖瓣置换术患者术中及术后应用瑞马唑仑的镇静效果及安全性。方法100例行二尖瓣置换术患者均采用静脉注射阿芬太尼30μg/kg、丙泊酚2.0 mg/kg、顺阿曲库铵0.2 mg/kg行常规麻醉诱导;50例术中静脉泵注瑞芬太尼0.4μg/(kg·min)+瑞马唑仑0.3~1.0 mg/(kg·h)维持麻醉为瑞马唑仑组,另50例静脉泵注瑞芬太尼0.4μg/(kg·min)+右美托咪定0.2~0.7μg/(kg·h)维持麻醉为右美托咪定组。2组患者术后均转入ICU继续行机械通气治疗,分别调整瑞马唑仑、右美托咪定浓度后持续静脉泵注,采用镇静躁动评分(sedation-agitation scale,SAS)评估患者镇静情况,维持SAS评分3~4分,出现躁动者静脉注射咪达唑仑1~2 mL加强镇静效果。比较2组体质量指数、手术时间、急性生理和慢性健康状况评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、并发症等;比较2组SAS评分、咪达唑仑人均使用量、咪达唑仑使用率,术后低血压、心动过缓、谵妄发生率,术后机械通气时间、ICU治疗时间、停药后苏醒时间。结果2组体质量指数、风湿性瓣膜病与瓣膜退行性变比例、ASA分级、NYHA心功能分级、手术时间、APACHEⅡ评分及合并高血压、糖尿病、冠心病比率比较差异均无统计学意义(P>0.05)。瑞马唑仑组术后低血压发生率(2.0%)低于右美托咪定组(16.0%)(χ^(2)=5.983,P=0.031),术后机械通气时间[(14.40±5.03)h]、ICU治疗时间[(31.70±8.03)h]、停药后苏醒时间[(23.25±2.71)min]均短于右美托咪定组[(17.25±3.57)h、(37.45±8.34)h、(27.65±4.42)min](P<0.05),SAS评分、咪达唑仑人均使用量、咪达唑仑使用率、心动过缓发生率、谵妄发生率与右美托咪定组比较差异均无统计学意义(P>0.05)。结论二尖瓣置换术中及术后应用瑞马唑仑可缩短患者苏醒时间及机械通气时间,减少术后低血压发生风险。Objective To observe the sedative effect and safety of remimazolam used during and after mitral valve replacement. Methods In 100 patients undergoing mitral valve replacement, anesthesia induction was performed by intravenous infusion of 30 μg/kg of alfentanil, 2.0 mg/kg of propofol, and 0.2 mg/kg of cisatracurium. Besides intraoperative intravenous pump of 0.4 μg/(kg·min) of remifentanil for anesthesia maintenance, 50 patients received 0.3 to 1.0 mg/(kg·h) of remimazolam(remimazolam group), and another 50 patients received 0.2 to 0.7 μg/(kg·h) of dexmedetomidine(dexmedetomidine group). After surgery, both two groups received mechanical ventilation treatment in ICU. The concentrations of remimazolam and dexmedetomidine were adjusted to maintain sedation-agitation scale(SAS) at 3 to 4, and 1 to 2 mL of midazolam was intravenously pumped to enhance the sedative effect when the patients were found restless. The clinical data as body mass index, operation lasting time, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) scores, complications, SAS score, per capita use of midazolam, rate of midazolam used, postoperative incidences of hypotension, bradycardia and delirium, postoperative mechanical ventilation time, length of ICU stay, and wake-up time after drug withdrawal were compared between two groups. Results There were no significant differences in the body mass index, percentages of patients with rheumatic valve disease and degenerative valve disease, ASA classification, NYHA classification, operation lasting time, APACHEⅡ score, and incidences of hypertension, diabetes and coronary heart disease between two groups(P>0.05). The incidence of hypotension was lower in remimazolam group(2.0%) than that in dexmedetomidine group(16.0%)(χ^(2)=5.983, P=0.031).The postoperative mechanical ventilation time,length of ICU stay and wake-up time were shorter in remimazolam group[(14.40±5.03)h,(31.70±8.03)h,(23.25±2.71)min]than those in dexmedetomidine group [(17.25±3.57)h,(37.45±8.34)h,(27.65±4.42)min
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