瑞马唑仑和丙泊酚用于肌萎缩性侧索硬化症患者行胃造瘘术后恢复质量的比较  

Comparison of the quality of recovery after gastrostomy in patients with amyotrophic lateral sclerosis receiving remimazolam and propofol

作　　者：龚静 王建中 陈小波 舒爱华 周密 李婷婷[2] 罗俊杰 GONG Jing;WANG Jianzhong;CHEN Xiaobo;SHU Aihua;ZHOU Mi;LI Tingting;LUO Junjie(Department of Anesthesionlogy,The Third People's Hospital,Yichang 443000;Department of Anesthesiology,Yichang Central People's Hospital,Yichang 443000,China)

机构地区：[1]宜昌市第三人民医院麻醉科,湖北宣昌443000 [2]宜昌市中心人民医院麻醉科,湖北宜昌443000

出　　处：《麻醉安全与质控》2024年第5期264-269,共6页Perioperative Safety and Quality Assurance

基　　金：宜昌市医疗卫生科研项目(A22-2-041)。

摘　　要：目的探讨瑞马唑仑用于肌萎缩性侧索硬化症(ALS)患者行经皮内镜下胃造瘘术(PEG)的麻醉诱导、维持的安全性和有效性及对患者术后呼吸功能恢复的影响。方法选取宜昌市中心人民医院2021-03/2023-06期间ALS患者64例,年龄35~65岁,体质量32~60 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法将患者分为瑞马唑仑组(n=32)和丙泊酚组(n=32)。瑞马唑仑组采用瑞马唑仑与瑞芬太尼麻醉诱导和麻醉维持,丙泊酚组采用丙泊酚与瑞芬太尼麻醉诱导和麻醉维持。术中持续监测脑电双频谱指数(BIS),根据BIS值调整药物泵注剂量,术中维持BIS值在40-60之间,两组患者均在手术结束时停用所有麻醉药物。记录患者入室平稳后的平均动脉压(MAP)和心率(HR),作为基础对照值,同时记录麻醉诱导时间,气管插管时(T 1)、手术切皮时(T 2)、手术开始后5 min(T 3)、苏醒后10 min(T 4)的MAP和HR;记录两组患者术后苏醒质量,包括术后呼之睁眼时间、拔管时间、麻醉恢复室(PACU)观察时间、患者出PACU的Steward评分,用超声记录并计算两组患者术后1 h膈肌运动幅度(DM)、膈肌厚度变化率(DTF)、术后72 h无创呼吸机总使用时间;记录术中应用血管活性药的次数及不良反应发生情况;用QoR-15量表记录患者术后24 h、48 h、72 h恢复质量评分。结果与丙泊酚组比较,瑞马唑仑组T 1、T 2、T 3时MAP和HR与基础值的差值更小,差异有统计学意义(P<0.05);瑞马唑仑组患者睁眼时间、拔管时间、PACU观察时间短于丙泊酚组,差异有统计学意义(P<0.05);瑞马唑仑组T 4、术后1 h的DM、DTF大于丙泊酚组;术后72 h无创呼吸机使用时间短于丙泊酚组;瑞马唑仑组应用血管加压药的次数少于丙泊酚组,差异有统计学意义(P<0.05);瑞马唑仑组患者头晕和嗜睡的例数少于丙泊酚组(P<0.05)。瑞马唑仑组患者术后24 h、术后48 h的QoR-15量表评分较丙泊酚组更高,差异有统计学意义(P<0.05)�Objective To investigate the safety and efficacy of remimazolam in anesthesia induction and maintenance of percutaneous endoscopic gastrostomy(PEG)in patients with amyotrophic lateral sclerosis(ALS)and its effect on postoperative respiratory recovery.Methods A total of 64 patients with ALS,aged 35-65 years,weighing 32-60 kg,ASAⅡorⅢ,in the Yichang Central People's Hospital from March 2021 to June 2023 were randomly divided into the remimazolam group(n=32)and the propofol group(n=32).Remimazolam and remifentanil were used in the remimazolam group,and propofol and remifentanil were used in the propofol group.The bispectral index(BIS)was continuously monitored during the operation,and the drug pump dose was adjusted according to the BIS value,and the BIS value was maintained between 40-60 during the operation.All anesthetic drugs were stopped at the end of the operation in both groups.The mean arterial pressure(MAP)and heart rate(HR)of the patients after stable entry were recorded as the basic control values.Meanwhile,the time of induction of anesthesia,the MAP and HR at the time of endotracheal intubation(T 1),the time of surgical incision(T 2),5 min after the start of surgery(T 3),and 10 min after recovery(T 4)were recorded.The quality of postoperative recovery,including eye opening time,extubation time,PACU observation time and Steward score of patients transferred out of PACU were recorded in 2 groups.Diaphragm movement amplitude(DM),diaphragm thickness change rate(DTF)and the operating time of non-invasive ventilator 72 h postoperatively were recorded by ultrasonography 1h after surgery.The times of application of vasoactive drugs and the occurrence of adverse reactions were recorded.QoR-15 scale was used to record the recovery index scores of the patients at 24 h,48 h and 72 h after surgery.Results Compared with the propofol group at T 1,T 2 and T 3,the difference of MAP and HR in the remimazolam group was less,and the difference was statistically significant(P<0.05).The eye opening time,extubation time and

关 键 词：瑞马唑仑 丙泊酚 肌萎缩性侧索硬化症 经皮内镜下胃造瘘术 麻醉苏醒质量 

分 类 号：R614[医药卫生—麻醉学]