不同剂量瑞马唑仑用于颅内动脉瘤血管介入术麻醉的临床研究  

Clinical trial on vascular intervention anesthesia of intracranial aneurysms using different doses of remimazolam

作　　者：郑德利[1] 王巨增 陈欢[1] 李慧利[1] 史记 孟莉[3] ZHENG De-li;WANG Ju-zeng;CHEN Huan;LI Hui-li;SHI Ji;MENG Li(Department of Anesthesia,The First Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China;Department of Interventional Therapy,The First Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China;Departmetnot of Neurology,The First Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China)

机构地区：[1]河北医科大学第一医院麻醉科,河北石家庄050000 [2]河北医科大学第一医院介入治疗科,河北石家庄050000 [3]河北医科大学第一医院神经内科,河北石家庄050000

出　　处：《中国临床药理学杂志》2024年第13期1860-1864,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的探究不同剂量瑞马唑仑全麻在颅内动脉瘤血管介入术麻醉中的应用效果及安全性分析。方法以颅内动脉瘤患者为研究对象,按照随机数字表法分为高、中和低剂量组。患者入室后开放静脉通路,密切监测生命体征,低、中、高剂量组分别静脉注射注射用瑞马唑仑0.25、0.30和0.35 mg·kg^(-1),待意识消失后均给予阿芬太尼、米库氯铵进行麻醉诱导。比较3组麻醉效果、苏醒质量及麻醉诱导前(T0)、置入喉罩时(T1)、栓塞时(T2)、术毕5 min(T3)和术毕30 min(T4)血流动力学指标、脑血流动力学指标、神经功能指标,并统计患者术后脑血管痉挛(CVS)、迟发性缺血性神经功能障碍(DIND)发生率及麻醉相关药物不良反应发生率。结果高、中和低剂量组的麻醉起效时间分别为(5.03±1.28)、(5.17±1.09)和(7.21±1.15)min,麻醉补救次数分别为(0.12±0.02)、(0.21±0.06)和(1.51±0.23)次,高、中剂量组上述指标与低剂量组比较,在统计学上差异有统计学意义(均P<0.05)。高、中和低剂量组氟马西尼拮抗治疗率分别为18.18%、11.11%和2.86%,T2时的平均动脉压(MAP)分别为(87.06±6.02)、(86.85±5.61)和(81.09±5.37)mmHg,T4时的MAP分别为(92.05±5.13)、(87.57±6.29)和(84.42±5.16)mmHg,高剂量上述指标与低剂量组比较,在统计学上差异有统计学意义(均P<0.05)。3组患者各时间段心率(HR)、血氧饱和度(SpO_(2))及左侧大脑中动脉峰值血流速度(Vp-MCA)、左侧大脑中动脉平均血流速度(Vm-MCA)及搏动指数(PI)、各时间段特异性蛋白100β(S100β蛋白)、神经元特异性烯醇化酶(NSE)水平比较,在统计学上差异均无统计学意义(均P>0.05)。3组CVS、DIND发生率及麻醉相关药物不良反应发生率比较,在统计学上差异均无统计学意义(均P>0.05)。结论不同剂量瑞马唑仑全麻在颅内动脉瘤血管介入治疗麻醉的安全性均较高,且对脑血流动力学及神经功能的影响相当,但高剂量瑞Objective To explore the application effect and safety of general anesthesia with different doses of remimazolam during vascular intervention anesthesia of intracranial aneurysms.Methods Patients with intracranial aneurysms were divided into high,middle and low dose groups according to the random number table method.The venous access was opened after the patients entered the room,and the vital signs were closely monitored.The low,middle and high dose groups were intravenously injected with 0.25,0.30 and 0.35 mg·kg^(-1)remazolam,respectively.After the loss of consciousness,alfentanil and mivacurium chloride were given for anesthesia induction.The anesthetic effect,recovery quality,hemodynamic indexes,cerebral hemodynamic indexes and neurological function indexes before anesthesia induction(T0),at the time of laryngeal mask insertion(T1),embolization(T2),5 min after operation(T3)and 30 min after operation(T4)were compared among the three groups.The incidence of postoperative cerebral vasospasm(CVS),delayed ischemic neurological dysfunction(DIND)and the incidence of adverse drug reactions related to anesthesia were counted.Results The onset times of anesthesia in the high,middle,and low dose groups were(5.03±1.28),(5.17±1.09),and(7.21±1.15)min,respectively;the number of anesthesia rescue interventions were(0.12±0.02),(0.21±0.06),and(1.51±0.23)times,respectively.There was statistically significant difference in the number of rescue interventions between the high and middle dose groups compared to the low dose group(all P<0.05).The therapeutic efficacy rates of flumazenil in the high,middle,and low dose groups were 18.18%,11.11%and 2.86%,respectively.the mean arterial pressure(MAP)at T2 were(87.06±6.02),(86.85±5.61)and(81.09±5.37)mmHg;the MAP at T4 were(92.05±5.13),(87.57±6.29)and(84.42±5.16)mmHg,respectively.There was statistically significant difference in MAP between the high and low dose groups(all P<0.05).There were no statistically significant differences in heart rate(HR),oxygen saturation(SpO_(2))

关 键 词：瑞马唑仑 用药剂量 麻醉 氟马西尼拮抗治疗 颅内动脉瘤 脑血流动力学 神经功能 安全性 

分 类 号：R971[医药卫生—药品]