甲苯磺酸瑞马唑仑与盐酸右美托咪定静脉麻醉对椎间孔镜下髓核摘除术患者围术期应激反应的影响  

Effects of intravenous anesthesia with remazolam and dexmedetomidine on perioperative stress and cognitive function in patients receiving endoscopic discectomy

作　　者：吴鼎 周敏 WU Ding;ZHOU Min(Department of Anesthesiology,Xuancheng Central Hospital,Xuancheng City,Anhui Province 242000,China)

机构地区：[1]安徽省宣城市宣城中心医院麻醉科,安徽宣城242000

出　　处：《颈腰痛杂志》2024年第5期925-928,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探究甲苯磺酸瑞马唑仑与盐酸右美托咪定麻醉对椎间孔镜下髓核摘除术患者围术期应激反应和术后认知功能的影响。方法选取2020年1月~2022年8月本院收治的行椎间孔镜下髓核摘除术患者90例,按照随机数字表法分为REM、DEX组,每组各45例,REM组术中使用甲苯磺酸瑞马唑仑静脉泵注,DEX组术中使用盐酸右美托咪定静脉泵注。比较术前和术后2 h,两组患者肾上腺素(E)、去甲肾上腺素(NE)及皮质醇(Cor)水平;记录两组患者入室后(T0)、切皮时(T1)、打磨关节时(T2)、髓核摘除时(T3)、手术结束时(T4)时间点的心率(HR)、脑电双频谱指数(BIS)、平均动脉压(MAP);记录不良反应发生情况。结果术后2 h,REM组患者E、NE及Cor水平均高于DEX组(P<0.05);T1、T2、T3、T4时,REM组患者HR、BIS、MAP水平均高于DEX组(P<0.05);术后24 h与72 h,REM组患者MMSE评分均高于DEX组(P<0.05);REM组与DEX组患者总不良反应的发生率比较,差异无统计学意义(P>0.05)。结论与盐酸右美托咪定相比,在椎间孔镜下髓核摘除术术中使用甲苯磺酸瑞马唑仑静脉麻醉,麻醉药持续时间短、术中血流动力学平稳。盐酸右美托咪定相较于甲苯磺酸瑞马唑仑在此类手术中静脉麻醉可更好地抑制患者手术应激反应,但易出现心动过缓、低血压的不良反应。Objective To investigate the effects of rimazolam mesylate and dexmedetomidine hydrochloride anesthesia on perioperative stress response and postoperative cognitive function in patients undergoing foraminoscopic nucleus pulposus removal.Methods 90 patients admitted to our hospital from January 2020 to August 2022 who underwent foraminoscopic nucleus pulposus removal were selected and divided into REM and DEX groups according to the random number table method,with 45 patients in each group.The levels of epinephrine(E),norepinephrine(NE)and cortisol(Cor)were compared between the two groups before and 2 h after surgery;the heart rate(HR),electroencephalographic bispectral index(BIS)and mean arterial pressure(MAP)were recorded at the time points of admission(T0),skin incision(T1),grinding of the joint(T2),removal of the nucleus pulposus(T3)and the end of surgery(T4)in the two groups,and the occurrence of adverse reactions was recorded.Results At 2 h after surgery,the levels of E,NE and Cor were higher in the REM group than in the DEX group(P<0.05);at T1,T2,T3 and T4,the levels of HR,BIS and MAP were higher in the REM group than in the DEX group(P<0.05);at 24 h and 72 h after surgery,the MMSE scores were higher in the REM group than in the DEX group(P<0.05);There was no statistically significant difference in the incidence of total adverse reactions between the REM and DEX groups(P>0.05).Conclusion Compared with dexmedetomidine hydrochloride,the use of intravenous anesthesia with remazolam mesylate during laminectomy for nucleus pulposus removal is associated with shorter anesthetic duration,faster postoperative cognitive recovery,and smooth intraoperative hemodynamics.Dexmedetomidine hydrochloride,compared with rimazolam mesylate,can better suppress the patient's surgical stress response in this type of surgery,but it is prone to the adverse effects of bradycardia and hypotension.

关 键 词：瑞马唑仑 右美托咪定 椎间孔镜手术 应激反应 认知功能 

分 类 号：R614[医药卫生—麻醉学]