不同剂量瑞马唑仑对腹横肌平面阻滞下行腹膜透析置管术肾衰竭患者的镇静效果比较  

Comparison of sedation effect of different doses of ramazolam on renal failure patients undergoing peritoneal dialysis catheterization under transversus abdominis plane block

作　　者：刘俊[1] 张永强[1] 李晓芳[1] 孙俊娜 赵际平 王云[2] 岳修勤[1] LIU Jun;ZHANG Yongqiang;LI Xiaofang;SUN Junna;ZHAO Jiping;WANG Yun;YUE Xiuqin(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;The Second Ward,Kidney Disease Hospital of the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院麻醉与围术期医学科,河南卫辉453100 [2]新乡医学院第一附属医院肾脏病医院二病区,河南卫辉453100

出　　处：《新乡医学院学报》2023年第10期926-931,共6页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20220591);北京医学奖励基金会资助项目(编号:YXJL-2021-0307-0634)。

摘　　要：目的 比较不同剂量瑞马唑仑对腹横肌平面阻滞(TAPB)下行腹膜透析置管术肾衰竭患者的镇静效果。方法 选择2021年4月至2022年8月于新乡医学院第一附属医院择期行腹膜透析置管术的120例肾衰竭患者为研究对象,根据治疗方法将患者分为低剂量组、中剂量组、高剂量组、对照组,每组30例。所有患者于术前行TAPB,TAPB完成后15 min,低剂量组、中剂量组、高剂量组患者静脉注射瑞马唑仑0.075 mg·kg^(-1),随即分别以0.2、0.4、0.6 mg·kg^(-1)·h^(-1)剂量维持静脉泵注;对照组患者静脉注射10 g·L^(-1)丙泊酚0.5 mg·kg^(-1),随即以2 mg·kg^(-1)·h^(-1)剂量维持泵注。分别于手术切皮时(T_(1))、分离皮下组织时(T_(2))、牵拉及切开腹膜时(T_(3))、放置腹膜透析管时(T_(4))、打皮下隧道时(T_(5))及手术结束时(T_(6)),采用视觉模拟评分法(VAS)评估各组患者的疼痛程度。分别于入室后5 min(T_(0))、T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时,记录各组患者的平均动脉压(MAP)和心率(HR)。分别于T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时,采用改良警觉镇静(MOAA/S)评分评估各组患者的镇静水平。记录各组患者苏醒时间,苏醒时间为瑞马唑仑或丙泊酚停药后至MOAA/S评分达到5分的时间。记录各组患者术中呼吸抑制(呼吸频率<6次·min^(-1)或呼吸暂停时间>20 s)发生次数,并计算术中呼吸抑制发生率。记录各组患者术后24 h内头晕、嗜睡、恶心、呕吐等不良反应发生情况。结果 T_(1)~T_(6)时,4组患者的VAS评分比较差异无统计学意义(P>0.05)。T_(1)~T_(5)时,低剂量组、中剂量组、高剂量组患者的MAP均显著高于对照组(P<0.05);T_(1)~T_(5)时,低剂量组、中剂量组、高剂量组患者的MAP比较差异无统计学意义(P>0.05);T_(0)、T_(6)时,4组患者的MAP比较差异无统计学意义(P>0.05)。T_(0)~T_(6)时,4组患者的HR比较差异无统计学意义(P>0.05)。T_(1)~T_(6)时,高剂量组患Objective To compare the sedative effect of different doses of remazolam on renal failure patients undergoing peritoneal dialysis catheterization under transversus abdominis plane block(TAPB).Methods A total of 120 patients with renal failure who underwent peritoneal dialysis catheterization at the First Affiliated Hospital of Xinxiang Medical University from April 2021 to August 2022 were selected as the research subjects.According to the treatment methods,the patients were divided into the low-dose group,medium-dose group,high-dose group and control group,with 30 cases in each group.All patients underwent TAPB before surgery.At 15 minutes after the completion of TAPB,patients in the low-dose group,medium-dose group and high-dose group received intravenous injection of 0.075 mg·kg^(-1) of ramazolam,and then maintained intravenous infusion at a dose of 0.2,0.4,0.6 mg·kg^(-1)·h^(-1),respectively;the patients in the control group received intravenous injection of 10 g·L^(-1) propofol at a dose of 0.5 mg·kg^(-1),followed by maintenance of pump infusion at a dose of 2 mg·kg^(-1)·h^(-1).At the time of surgical skin incision(T_(1)),subcutaneous tissue separation(T_(2)),peritoneal traction and incision(T_(3)),peritoneal dialysis tube placement(T_(4)),subcutaneous tunneling(T_(5))and surgical end(T_(6)),the pain level of patients in each group was evaluated by the visual analog scale(VAS)method.The mean arterial pressure(MAP)and heart rate(HR)of patients in each group were recorded at 5 min after entry(T 0),T_(1),T_(2),T_(3),T_(4),T_(5) and T_(6).At T_(1),T_(2),T_(3),T_(4),T_(5) and T_(6),the sedation level of patients in each group was evaluated by the modified observer′s assessment of alert/sedation(MOAA/S)score.The awakening time of patients in each group was recorded,which was the time from the cessation of medication with remidazolam or propofol until the MOAA/S score reached 5 scores.The number of occurrences of intraoperative respiratory suppression(respiratory rate<6 times per minute or apnea time>20 s)i

关 键 词：瑞马唑仑 腹横肌平面阻滞 肾衰竭 腹膜透析置管术 镇静 

分 类 号：R692.5[医药卫生—泌尿科学]