苯磺酸瑞马唑仑复合阿芬太尼对日间甲状腺肿物切除术患者血流动力学、麻醉复苏及镇痛镇静效果的影响  

Effect of remimazolam besylate combined with alfentanil on hemodynamics,anesthetic recovery,analgesic and sedative effect in patients undergoing daytime thyroidectomy

作　　者：邵晓雨 王守国 宁德发[1] 薛艳芝 肖林 张树卿[1] SHAO Xiaoyu;WANG Shouguo;NING Defa;XUE Yanzhi;XIAO Lin;ZHANG Shuqing(Department of Anesthesiology and Perioperative Medicine,Dezhou People's Hospital,Dezhou 253000,Shandong,China)

机构地区：[1]德州市人民医院麻醉与围术期医学科,山东省德州市253000

出　　处：《广西医学》2023年第15期1817-1821,共5页Guangxi Medical Journal

基　　金：山东省医学会镇痛镇静-麻醉优化专项课题(YXH2022ZX05269)。

摘　　要：目的探讨苯磺酸瑞马唑仑复合阿芬太尼对日间甲状腺肿物切除术患者血流动力学、麻醉复苏及镇痛镇静效果的影响。方法回顾性分析行日间甲状腺肿物切除术的108例患者的临床资料,按照麻醉方法将患者分为研究组和对照组,各54例。两组患者均接受经口气管插管全凭静脉麻醉,研究组、对照组的麻醉诱导药物分别为苯磺酸瑞马唑仑+盐酸阿芬太尼+苯磺顺阿曲库铵、丙泊酚+盐酸阿芬太尼+苯磺顺阿曲库铵,麻醉维持药物分别为苯磺酸瑞马唑仑+盐酸阿芬太尼、丙泊酚+盐酸阿芬太尼。比较两组患者术前(T_(0))、切皮时(T_(1))、手术开始后15 min(T_(2))、剥离肿物时(T_(3))及手术结束时(T_(4))的血流动力学指标,麻醉复苏情况(睁眼所需时间、意识恢复所需时间、气管拔管时间、恢复室停留时间),术后1 h、3 h、6 h、12 h数字疼痛评估量表(NRS)评分、Ramsay镇静评分,以及不良反应发生情况。结果(1)在T_(1)、T_(2)、T_(3)、T_(4),两组患者的收缩压、舒张压、心率高于T_(0),而研究组患者的收缩压、舒张压、心率低于对照组(P<0.05)。(2)研究组患者睁眼所需时间、意识恢复所需时间、气管拔管时间及恢复室停留时间短于对照组(P<0.05)。(3)随着观察时间的延长,两组患者的NRS评分逐渐降低、Ramsay镇静评分逐渐升高,且研究组患者各时间点的NRS评分及Ramsay镇静评分优于对照组(P<0.05)。(4)研究组患者的不良反应总发生率低于对照组(P<0.05)。结论苯磺酸瑞马唑仑复合阿芬太尼在日间甲状腺肿物切除术全凭静脉麻醉中应用效果良好,与丙泊酚复合阿芬太尼的麻醉方案相比,该麻醉方案可更好地稳定患者术中血流动力学,促进患者麻醉复苏,具有良好的镇痛镇静效果,且用药安全性良好。Objective To explore the effect of remimazolam besylate combined with alfentanil on hemodynamics,anesthetic recovery,analgesic and sedative effect in patients undergoing daytime thyroidectomy.Methods The clinical data of 108 patients who underwent daytime thyroidectomy were analyzed retrospectively,and patients were assigned to study group or control group according to anesthetic methods,with 54 cases in each group.Both groups received orotracheal intubation total intravenous anesthesia,and anesthetic induction drugs were remimazolam besylate+alfentanil hydrochloride+cisatracurium besylate,and propofol+alfentanil hydrochloride+cisatracurium besylate for the study group and the control group,respectively;furthermore,the anesthetic maintenance drugs were remimazolam besylate+alfentanil hydrochloride,and propofol+alfentanil hydrochloride for the study group and the control group,respectively.Hemodynamic indices before operation(T_(0)),at incision(T_(1)),at 15 minutes after the beginning of operation(T_(2)),at goitre removing(T_(3)),and in the end of operation(T_(4)),anesthetic recovery(time to open eyes,time to regain consciousness,tracheal extubation time,length of stay in the recovery room),and the Numerical Rating Scale(NRS)score,Ramsay sedation score after 1,3,6,and 12 hours of operation,as well as the occurrence of adverse reactions were compared between patients of the two groups.Results(1)At T_(1),T_(2),T_(3),and T_(4),both groups exhibited higher systolic pressure,diastolic pressure,and heart rate as compared with T_(0),whereas the study group yielded lower systolic pressure,diastolic pressure,and heart rate as compared with the control group(P<0.05).(2)The study group interpreted shorter time to open eyes,time to regain consciousness,tracheal extubation time,and length of stay in the recovery room as compared with the control group(P<0.05).(3)With the extension of observation time,the NRS score of the two groups gradually decreased,Ramsay sedation score gradually increased,and the NRS score and Ramsay sedat

关 键 词：甲状腺肿物切除术 苯磺酸瑞马唑仑 阿芬太尼 血流动力学 麻醉复苏 镇痛 镇静 日间手术 

分 类 号：R581[医药卫生—内分泌]