2种剂量瑞马唑仑在衰弱老年肺叶切除术患者麻醉中的效果及安全性分析  

Efficacy and Safety Analysis of Two Doses of Remazolam in Anaesthesia in Frail Elderly Patients Undergoing Pulmonary Lobectomy

作　　者：张晶晶 刘辉[2] 王亮 ZHANG Jingjing;LIU Hui;WANG Liang(Department of Anesthesiology,the First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075041,China;Department of Anesthesiology,the First Hospital of Hebei North College,Zhangjiakou,Hebei 075000,China;Department of General Practice,Qiaoxi District Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市第一医院麻醉科,河北张家口075000 [2]河北北方学院附属第一医院麻醉科,河北张家口075000 [3]张家口市桥西区医院全科医学科,河北张家口075000

出　　处：《转化医学杂志》2023年第4期198-203,共6页Translational Medicine Journal

基　　金：河北省卫生健康委科研基金项目青年科技课题(20190909)。

摘　　要：目的探究2种剂量瑞马唑仑在衰弱老年肺叶切除术患者中的应用价值。方法选取2022年5月—2023年1月衰弱老年肺叶切除术患者98例,根据瑞马唑仑使用剂量的不同均分为A、B 2组。A组在麻醉诱导时静脉推注0.2 mg/kg瑞马唑仑,B组在麻醉诱导时静脉推注0.3 mg/kg瑞马唑仑。比较2组手术及麻醉相关指标,不同时点[入室平静时(T0)、改良警觉/镇静评分为0分时(T1)、收缩压最低时(T2)、麻醉苏醒后(T3),术后24 h(T4)、术后72 h(T5)]心率(HR)、平均动脉压(MAP)、T淋巴细胞(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))和简易智能精神状态检查量表(MMSE)评分,以及并发症发生情况。结果A组镇静起效时间长于B组,补救镇痛率高于B组,瑞马唑仑用量少于B组(P<0.05,P<0.01)。T1、T2时A组MAP、HR高于B组(P<0.05)。T4时2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、MMSE评分均较T0时降低,且A组低于B组(P<0.05)。2组并发症总发生率比较差异无统计学意义(P>0.05),但A组术后谵妄发生率(12.24%,6/49)高于B组(0,0/49)(P<0.05)。结论2种剂量瑞马唑仑均能使衰弱老年患者肺叶切除术顺利实施,但高剂量瑞马唑仑能降低创伤应激对患者血流动力学、免疫功能的影响,同时能减轻认知功能损伤,且具有较高的安全性。Objective To investigate the application value of 2 doses of Remazolam in frail elderly patients undergoing pulmonary lobectomy.Methods A total of 98 frail elderly patients undergoing pulmonary lobectomy from May 2022 to January 2023 were selected and divided into groups A and B2 according to the different doses of Remazolam used.Group A was given 0.2 mg/kg Remazolam intravenously during anesthesia induction,and group B was given 0.3 mg/kg remazolam intravenously during anesthesia induction.The indexes related to surgery and anesthesia,heart rate(HR),mean arterial pressure(MAP),T lymphocyte CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)and Mini-mental State Examination(MMSE)scores at different time points[at calmness at entering the operating room(T0),modified alertness/sedation score of 0(T1),systolic blood pressure at the lowest point(T2),after anesthesia recovery(T3),at 24 h after surgery(T4),at 72 h after surgery(T5)],and the incidence of complications between the two groups were compared.Results The duration of sedation in group A was longer than that in group B,the rate of relief analgesia was higher than that in group B,and the dosage of Remazolam was lower than that in group B(P<0.05,P<0.01).MAP and HR in group A were higher than those in group B at T1 and T2(P<0.05).The scores of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and MMSE at T4 were lower than those at T0,and lower in group A than in group B(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05),but the incidence of postoperative delirium in group A(12.24%,6/49)was higher than that in group B(0,0/49)(P<0.05).Conclusion Both doses of Remazolam can ensure successful lobectomy in frail elderly patients,but high doses of Remazolam can reduce the effects of traumatic stress on hemodynamics and immune function,and reduce cognitive function impairment,with high safety.

关 键 词：肺肿瘤 肺叶切除术 老年人 瑞马唑仑 剂量 血流动力学 细胞免疫 认知功能 

分 类 号：R734.2[医药卫生—肿瘤]