基于BIS和微旁流EtCO_(2)监护下甲苯磺酸瑞马唑仑在日间宫腔镜手术麻醉中的有效性和安全性  

A randomized controlled study of remimazolam tosilate under bispectral index and bypass EtCO2 monitoring in daytime hysteroscopic surgery

作　　者：张俊杰[1,2] 杨晓春 刘卓懿[1,2] 吴若秋 李平 郭曲练 王锷 ZHANG Junjie;YANG Xiaochun;LIU Zhuoyi;WU Ruoqiu;LI Ping;GUO Qulian;WANG E(Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders,Changsha 410008,China;不详)

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008 [2]国家老年疾病临床医学研究中心,长沙410008 [3]中南大学湘雅医院妇产科,长沙410008

出　　处：《实用医学杂志》2024年第8期1047-1051,共5页The Journal of Practical Medicine

基　　金：湖南省自然科学基金项目(编号:2021JJ31124);湖南省医学会科研基金(编号:HMA202101011);中华健康促进基金会“湘渝临床科研基金”。

摘　　要：目的研究甲苯磺酸瑞马唑仑用于日间宫腔镜手术麻醉中的有效性和安全性。方法采用随机对照设计,纳入行日间宫腔镜手术患者300例,采用随机数字随机分为两组。年龄18~60岁,BMI18.5~27 kg/m~2,ASAⅠ-Ⅱ级。R组应用甲苯磺酸瑞马唑仑,P组应用丙泊酚作为对照。所有患者在手术开始前5 min予以舒芬太尼0.1μg/kg缓慢静脉注射。R组甲苯磺酸瑞马唑仑首剂予以0.2 mg/kg缓慢静脉注射,根据镇静深度单次予以0.05 mg/kg追加。P组丙泊酚首剂予以1.5~2 mg/kg缓慢静脉注射,根据镇静深度单次予以0.5 mg/kg追加。所有患者入室后持续监测并记录心电图、SpO_(2)、NIBP、HR、BIS、微旁流EtCO_(2)。记录所有患者的麻醉效果相关指标(包括麻醉药物起效时间、手术时间、苏醒时间及离室时间),安全性指标(低血压、低氧饱和度、恶心呕吐等不良事件),医师和患者的满意度。结果甲苯磺酸瑞马唑仑用于日间宫腔镜手术中镇静深度满足临床要求,低血压和注射痛发生率低(P<0.01),呼吸抑制更轻(P<0.05),手术时间、离室时间、恶心呕吐及满意度等差异均无统计学意义(P>0.05)。结论甲苯磺酸瑞马唑仑用于日间宫腔镜检镇静深度合适,低血压、注射痛发生率低,呼吸抑制更轻微,甲苯磺酸瑞马唑仑复合舒芬太尼可安全有效地应用于日间宫腔镜手术的麻醉。Objective To study the efficacy and safety of remimazolam tosilate in painless daytime hysteroscopic surgery.Methods A total of 300 patients(18 ~ 60 years,BMI 18.5 ~ 27 kg/m2,and ASA Ⅰ-Ⅱ) undergoing selected painless daytime hysteroscopic surgery were randomized into two groups.Group R received remimazolam tosilate at an initial dose of 0.2 mg/kg,and then single 0.05 mg/kg if needed according to bispectral index.Group P,according to the bispectral index,received propofol at an initial dose of 1.5 ~ 2 mg/kg,and single 0.5 mg/kg if needed.All the patients were intravenously given 5 μg sufentanil five minutes before hysteroscopy.The anesthesia-related indicators(anesthesia onset time,surgical duration,anesthesia recovery time,and time to leaving the operating room) and safety indexes(hypotension,hypoxia,nausea and vomiting,and doctor and patient satisfaction) were recorded.Results The incidence of hypotension and injection pain was significantly higher in group P(P < 0.01).There were no significant differences between the two groups in surgical duration,awakening time,time to leaving the operating room,nausea and vomiting,and patient satisfaction(P > 0.05).Conclusion Remimazolam can be used safely and effectively in painless daytime hysteroscopic surgery.

关 键 词：日间手术 甲苯磺酸瑞马唑仑 丙泊酚 宫腔镜 注射痛 低血压 

分 类 号：R614[医药卫生—麻醉学]