不同剂量瑞马唑仑用于老年患者喉罩全麻诱导时对血流动力学参数影响的双盲随机对照研究  

Effect of remimazolam with different doses on hemodynamic changes in elderly patients under general anesthesia

作　　者：薛小云 徐成 韩小莉 王莉斯 倪文宗 XUE Xiaoyun;XU Cheng;Han Xiaoli;Wang Lisi;NI Wenzong(Department of Anesthesiology,Shanghai Sixth People Hospital Haikou Orthopedic and Diabetics Hospital,Haikou 570311,China;Department of Anesthesiology,Shanghai Six People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海市第六人民医院海口骨科与糖尿病医院麻醉科,海口570311 [2]上海交通大学医学院附属第六人民医院麻醉科,上海200233

出　　处：《同济大学学报（医学版）》2023年第4期574-579,共6页Journal of Tongji University(Medical Science)

基　　金：海南省卫生健康委员会项目(2001032021A2006)。

摘　　要：目的探索不同剂量瑞马唑仑用于老年患者喉罩全麻诱导时对血流动力学参数变化差值的影响。方法择期行喉罩全麻的老年患者患者120例,年龄6080岁,性别不限,BMI为1827 kg/m 2,ASAⅠⅢ级,按照随机数字表法分4组:丙泊酚组(P组,2 mg/kg,n=58)、低剂量瑞马唑仑组(R1组,0.2 mg/kg,n=57)、中等剂量瑞马唑仑组(R2组,0.3 mg/kg,n=57)和高剂量瑞马唑仑组(R3组,0.4 mg/kg,n=58)。所有患者诱导时用瑞芬太尼0.5μg/kg/min进行镇痛。术中镇静深度用脑电双频指数(BIS)监测并维持在4060。主要结局是从麻醉诱导开始到喉罩置入后3 min内低血压(MAP<65 mmHg)的发生率。次要结果包括从开始输注瑞马唑仑到意识消失的时间(loss of consciousness,LOC)及诱导开始后5 min内BIS、MAP和心率变化。记录、麻醉诱导期间相关不良事件的发生情况。结果与P组(55%)相比,R1组(26%)和R2组(32%)低血压发生率显著降低(P<0.05),R3组(49%)与P组(55%)低血压发生率相似(P>0.05);与P组相比,R1、R2和R3组诱导后LOC均显著延长(P<0.05);R1和R2组在诱导后5 min内BIS值、MAP和心率都显著高于P组和R3组(P<0.05)。R1组补救镇静率显著高于其他3组(P=0.002)。4组患者围手术期不良事件发生情况相似。结论0.2 mg/kg或0.3 mg/kg瑞马唑仑可安全有效的用于老年患者喉罩麻醉的诱导,而0.3 mg/kg瑞马唑仑可维持更稳定的镇静效果。Objective To explore the effect of remimazolam with different doses on hemodynamic changes during general anaesthesia induction in elderly patients.Methods One hundred and twenty patients,aged 60-80 years with ASAⅠ-Ⅲ,who underwent elective surgery with laryngeal mask general anesthesia,were randomly divided into 4 groups:group P(given propofol 2 mg/kg during induction,n=58),group R1(given remimazolam 0.2 mg/kg,n=57),group R2(given remimazolam 0.3 mg/kg,n=57)and group R3(given remimazolam 0.4 mg/kg,n=58).All patients were sedated with remifentanil 0.5μg/kg/min at induction.The depth of intraoperative sedation was monitored with the electroencephalographic bifrequency index(BIS)and maintained at 40 to 60.The primary outcome was the incidence of hypotension(MAP<65 mmHg)from the start of induction of anesthesia to 3 min after mask placement.Secondary outcomes included time from the start of remimazolam infusion to loss of consciousness(LOC),electroencephalographic BIS,MAP and heart rate variability within 5 min of the start of induction.The occurrence of adverse events associated with the induction of anesthesia was recorded.Results The incidence of hypotension was significantly lower in the group R1(26%)and group R2(32%)compared to the group P(55%)(P<0.05),while that was similar in the group R3(49%)(P>0.05).Compared to the group P,LOC was significantly prolonged in the groups R1,R2 and R3 after induction(P<0.05).The BIS values,MAP and heart rate were significantly higher in the groups R1 and R2 than those in groups P and R3 within 5 min after induction(P<0.05).In addition,the rate of remedial sedation was significantly higher in the group R1 than that in the other three groups(P=0.002).There was no significant difference in the incidence of perioperative adverse events among 4 groups.Conclusion Remimazolam at dose of 0.2 mg/kg or 0.3 mg/kg can be used safely and effectively for the induction of mask general anaesthesia in elderly patients,while the remimazolam of 0.3 mg/kg can maintain a more stable sedation ef

关 键 词：瑞马唑仑 血流动力学 老年 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]