靶控输注瑞马唑仑用于腹部手术的临床观察  

Target-controlled infusion of remimazolam for abdominal surgery:a clinical observation protocol

作　　者：杨晓莉 李姣 李慧芬 YANG Xiaoli;LI Jiao;LI Huifen(Graduate School,Changzhi Medical College;Department of Anesthesiology,Heping Hospital Affiliated to Changzhi Medical College;Department of Anesthesiology,Heji Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]长治医学院研究生院 [2]长治医学院附属和平医院麻醉科 [3]长治医学院附属和济医院麻醉科,山西长治046000

出　　处：《麻醉安全与质控》2024年第5期245-249,共5页Perioperative Safety and Quality Assurance

基　　金：山西省医师协会项目(YSXH-RF2022MZ009)。

摘　　要：目的比较瑞马唑仑靶控输注(TCI)和恒速泵注对全身麻醉诱导的作用,评价三室模型和代谢物转运室的二室模型参数应用于患者瑞马唑仑TCI系统的性能。方法选取2023年3~5月长治医学院附属和平医院麻醉科行腹部手术患者60例,年龄18~65岁,男女不限,ASA分级Ⅰ~Ⅲ级。采用随机数字表法将患者分为对照组(n=30)和试验组(n=30),对照组采用瑞马唑仑恒速泵注,试验组采用瑞马唑仑靶控输注,使用脑电双频谱指数(BIS)监测麻醉深度,待BIS值达60时,设定瑞芬太尼TCI效应室浓度5 ng/mL,给予单次剂量0.6 mg/kg的罗库溴铵;达插管条件完成气管插管。记录诱导期不同时间点入室后10 min(T 0)、意识消失后(T_(1))、插管前(T_(2))、插管后1 min(T_(3))、插管后3 min(T_(4))、插管后5 min(T_(5))的收缩压(SBP)、平均动脉压(MAP)、心率(HR)、心指数(CI)、BIS;从给药开始至BIS≤60的时间;诱导过程中血管活性药物使用情况及相关不良反应。结果与基础值相比,两组患者给药后SBP、MAP、CI、BIS均有所下降,波动幅度较小,HR均有所上升,差异有统计学意义(P<0.05);试验组和对照组从开始给药至BIS下降至60的时间分别为(126.6±21.6)s和(354.9±98.8)s,差异有统计学意义(P<0.05);试验组不良反应出现低血压3例、心动过速3例,心动过缓4例,呃逆2例;对照组不良反应出现高血压1例、低血压1例、心动过缓1例,出现呃逆4例,两组患者不良反应比较,差异无统计学意义(P>0.05)。结论TCI和恒速泵注瑞马唑仑均可维持患者麻醉诱导期的血流动力学稳定,安全用于全身麻醉的麻醉诱导。Objective To compare the effects of target-controlled infusion(TCI)and constant-rate pump infusion of remimazolam on general anesthesia induction,and to evaluate the performance of three-compartment model and two-compartment model with transit compartment for the metabolite applied to the patient's remimazolam TCI system.Methods A total of 60 patients of either gender,aged 18-65 years,ASAⅠ-Ⅲ,undergoing abdominal surgery in the Affiliated Heping Hospital,Changzhi Medical College from March to May 2023 were selected and randomly divided into the control group(n=30)and the experimental group(n=30).Remimazolam was given as a target controlled infusion to the experimental group and as a constant velocity pump injection to the control group with bispectral index(BIS)to track the depth of anesthesia.When the BIS value reached 60,the TCI of remifentanil was maintained at the effect-site concentration of 5 ng/mL,and a single dose of 0.6 mg/kg rocuronium was administrated.The systolic blood pressure(SBP),mean arterial pressure(MAP),heart rate(HR),heart index(CI),BIS value were recorded before anesthesia induction(T 0),after loss of consciousness(T_(1)),before intubation(T_(2)),1 min after intubation(T_(3)),3 min after intubation(T_(4)),and 5 min after intubation(T_(5)).Meanwhile,the duration from the beginning of administration to BIS≤60,the use of vasoactive drugs and related adverse reactions during induction were also recorded.Results Compared with the baseline value,SBP,MAP,CI and BIS of both groups showed a slight decrease after administration.However,there was a significant increase in HR(P<0.05).The time from the start of administration to BIS declining to 60 in the experimental group and control group were(126.6±21.6)s and(354.9±98.8)s,respectively,with a statistically significant difference(P<0.05).In the experimental group,there were 3 cases of hypotension,3 cases of tachycardia,4 cases of bradycardia,and 2 cases of hiccup.In the control group,there were 1 cases of hypertension,1 cases of hypotension and

关 键 词：靶控输注 瑞马唑仑 稳态血药浓度 血流动力学 

分 类 号：R614[医药卫生—麻醉学]