术前小剂量瑞马唑仑对胸腔镜下肺切除术患者插管应激反应及苏醒质量的影响  

Effect of preoperative low-dose remimazolam on intubation stress response and quality of recovery in patients undergoing thoracoscopic pulmonary resection

作　　者：段鹏 王滢 孙莹杰 陈晓宇 Duan Peng;Wang Ying;Sun Yingjie;Chen Xiaoyu(Department of Anesthesiology,Northern Theater Command General Hospital,Shenyang 110001,China)

机构地区：[1]北部战区总医院麻醉科,辽宁沈阳110001

出　　处：《实用药物与临床》2024年第2期106-110,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨术前静脉注射小剂量瑞马唑仑对胸腔镜下肺切除术患者插管应激反应及苏醒质量的影响。方法选择北部战区总医院胸外科2021年9月至2023年5月拟胸腔镜下行肺叶切除术且自愿参加本研究的80例患者为研究对象,性别不限,年龄25~45岁,BMI 18~25 kg/m^(2),ASAⅡ或Ⅲ级,随机分为2组,每组40例。麻醉诱导前试验组给予瑞马唑仑0.2 mg/kg,对照组给予等量生理盐水。记录两组患者麻醉诱导前给药前后的平均动脉压(MAP)、心率(HR)、氧饱和度(SpO_(2))值,气管插管前后测定血糖、乳酸、促肾上腺皮质激素水平,术后睁眼时间、Ramsay镇静评分、躁动评分、呼吸抑制、恶心呕吐及其他不良反应发生率,以及苏醒后30 min、1 h的视觉模拟疼痛评分(VAS)评分。结果麻醉诱导前,给药后试验组与对照组MAP[(87.00±0.72)mmHg vs.(86.32±3.73)mmHg]、HR[(77.90±2.09)次/min vs.(77.80±4.05)次/min]、SpO_(2)(98.35%±0.74%vs.98.03%±0.80%)比较,差异无统计学意义(P>0.05)。插管后,试验组血糖[(6.48±0.51)mmol/L vs.(7.98±0.80)mmol/L]、乳酸[(1.58±0.50)mmol/L vs.(2.15±0.83)mmol/L]、促肾上腺皮质激素水平[(36.30±1.68)mmol/L vs.(37.60±1.60)mmol/L]低于对照组(P<0.05)。试验组苏醒室停留时间[(27.65±1.58)min vs.(32.65±1.67)min]短于对照组,且拔管时呛咳(15.0%vs.37.5%)、躁动(7.5%vs.30.0%)、寒战(5.0%vs.25.0%)的发生率及苏醒后30 min、1 h VAS低于对照组,Ramsay镇静评分高于对照组(2.70±0.46 vs.1.56±0.50,P<0.05)。结论术前静脉注射小剂量瑞马唑仑可加速胸腔镜下肺切除术患者苏醒,减少患者不适和疼痛,对血压和心率影响较小。Objective To investigate the effect of intravenous injection of low-dose remimazolam on the intubation stress response and quality of recovery in patients undergoing thoracoscopic pulmonary resection.Methods A total of 80 patients undergoing thoracoscopic pulmonary resection in the Department of Thoracic Surgery of the Northern Theater Command General Hospital from September 2021 to May 2023 who volunteered to participate in this study were selected as the study subjects,regardless of gender,aged 25~45 years old,BMI 18~25 kg/m^(2),and ASA grade Ⅱ or Ⅲ.They were randomly divided into two groups,with 40 cases in each group.Before anesthesia induction,the experimental group was given remimazolam 0.2 mg/kg,and control group was given the same amount of normal saline.The levels of mean arterial pressure(MAP),heart rate(HR)and oxygen saturation(SpO_(2))of the two groups were recorded before and after medication.The levels of blood glucose,lactic acid and adrenocorticotropin were detected before and after endotracheal intubation.Eye opening time,Ramsay sedation score,agitation score,respiratory depression,nausea and vomiting and other adverse reactions were recorded.VAS scores at 30 min and 1 h after recovery were recorded.Results There was no significant difference in MAP[(87.00±0.72)mmHg vs.(86.32±3.73)mmHg],HR[(77.90±2.09)bpm vs.(77.80±4.05)bpm]or SpO_(2)(98.35%±0.74%vs.98.03%±0.80%)between experimental group and control group after medication before anesthesia induction(P>0.05).After intubation,the levels of blood glucose[(6.48±0.51)mmol/L vs.(7.98±0.80)mmol/L],lactic acid[(1.58±0.50)mmol/L vs.(2.15±0.83)mmol/L]and adrenocorticotropin[(36.30±1.68)mmol/L vs.(37.60±1.60)mmol/L]in experimental group were lower than those in control group(P<0.05).The retention time in recovery room of experimental group[(27.65±1.58)min vs.(32.65±1.67)min]was shorter than that of control group(P<0.05);the incidence of coughing(15.0%vs.37.5%),agitation(7.5%vs.30.0%)and chills(5.0%vs.25.0%)during extubation and the VAS sc

关 键 词：瑞马唑仑 胸腔镜 肺切除术 苏醒质量 疼痛 

分 类 号：R614[医药卫生—麻醉学]