苯磺酸瑞马唑仑在颅内动脉瘤栓塞术中的临床应用  

Clinical application of remimazolam besylate in intracranial aneurysm embolization

作　　者：李秀杰[1] 邢娜[1] LI Xiujie;XING Na(Department of Anesthesia and Perioperative and Pain Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,CHN)

机构地区：[1]郑州大学第一附属医院麻醉与围手术期及疼痛医学部,郑州450000

出　　处：《河南大学学报（医学版）》2024年第6期460-463,共4页Journal of Henan University:Medical Science

摘　　要：目的:探讨苯磺酸瑞马唑仑在神经介入颅内动脉瘤栓塞术中的临床应用。方法:选择拟在全麻下行颅内动脉瘤栓塞术的患者70例,性别不限,年龄18~65岁。Ⅰ、Ⅱ或Ⅲ级,体质量指数(BMI)18~28kg·m^(-2),采用随机数字表法分为2组:丙泊酚组(P组)和苯磺酸瑞马唑仑组(R组)。麻醉诱导时P组静脉注射丙泊酚2mg·kg^(-1),R组静脉推注苯磺酸瑞马唑仑0.2mg·kg^(-1),待患者意识消失后两组均给予阿芬太尼10μg·kg^(-1),米库氯铵0.2mg·kg^(-1)。置入喉罩后P组与R组分别泵注丙泊酚4~8mg/(kg·h)、苯磺酸瑞马唑仑0.2~1mg/(kg·h),两组均泵注瑞芬太尼0.1μg/(kg·min)、米库氯铵0.2mg/(kg·h)。于诱导前(T0)、置入喉罩时(T1)、置入喉罩5min(T2)、停用麻药时(T3)、拔除喉罩时(T4)、拔除喉罩5min(T5)时分别记录血压(BP)、心率(HR)、脑电双频谱指数(BIS)值和改良警觉/镇静评分(MOAA/S评分)。记录麻醉开始至手术开始时间、手术时长、给药结束至拔除喉罩时间、恢复自主呼吸时间。记录术中与术后心动过缓、心动过速、高血压、低血压、注射痛、头晕和嗜睡等不良事件或反应,采用Brice问卷法记录术中知晓情况。结果:本研究计划纳入70例,每组35例,排除手术原因昏迷不醒者、术中因液体不畅或其他因素导致实验无法完成者,最终每组纳入30例。与T0比,P组在T1、T2、T3、T4时收缩压明显下降(P<0.05),T1、T2、T3时舒张压均明显下降(P<0.05),在T1、T2、T3时HR明显下降(P<0.05);R组在T1、T3、T5时收缩压明显下降(P<0.05),在T1、T2、T3时舒张压明显下降(P<0.05),在T1、T4、T5时HR无明显下降(P=0.443)。与P组相比,R组在T2、T5时舒张压升高(P<0.05),在T1、T2、T4时HR增快(P<0.05)。与P组相比,R组苏醒时间缩短(P<0.05),拔管时间缩短(P<0.05),R组无注射痛,总体不良反应发生率低(χ^(2)=7.94,P<0.05)。结论:苯磺酸瑞马唑仑可安全用于神经介入颅内动脉瘤栓塞术时的麻醉Objective:To investigate the clinical application of remimazolam besylate in patients undergoing intracranial aneurysm embolization surgery.Methods:Seventy patients of both sexes,aged 18-65 y,with body mass index(BMI18~28 kg/m,American Society of Anesthesiologists(ASA)physical statusⅠ、ⅡorⅢ,scheduled for intracranial aneurysm embolization surgery,were divided into two groups using a random number table method(n=35):remimazolam besylate(group R)and propofol(group P).Propofol 2 mg/kg was given intravenously in group P,and remimazolam besylate 0.2 mg/kg was given intravenously in group R during anesthesiainduction.Alfentanil 10μg/kg and micuronium chloride 0.2 mg/kg were given in both groups after the patients lost consciousness.After laryngeal mask placement,propofol 4~8 mg·kg^(-1)·h^(-1),remimazolam besylate 0.3~1.0 mg·kg^(-1)·h^(-1)and remifentanil 0.1μg·kg^(-1)·min^(-1)and micuronium chloride 0.2 mg·kg^(-1)·h^(-1)were injected by pump in group P and group R.Recorded blood pressure and heart rate,BIS values,and modified Observer's Assessment of Alert/Sedation(mOAA/S)before anesthesia induction(To),when placing a laryngeal mask(T1),5 min after laryngeal mask insertion(T2),at the time of anesthesia withdraw(T3),at the time of laryneal mask removal(T4)and 5 min after laryngeal mask removal(T5).The time from the start of anesthesia to the withdrawal of anesthesia(anesthesia time),the time from the beginning of surgery to the end of surgery(operation time),and the time from the end of administration to recovery(recovery time),and the time from the end of administration to the removal of laryngeal mask(extubation time)were recorded.The intraoperative and postoperative adverse events or reactions were recorded,such as bradycardia,hypotension,injection pain,dizziness and drowsiness.The intraoperative awareness was recorded using the Brice questionnaire method.Results:Compared with T0,in group P,systolic blood pressure(SBP)decreased significantly at T1,T2,T3 and T4(P<0.05),and diastolic blood pressure(DBP

关 键 词：苯磺酸瑞马唑仑 颅内动脉瘤 丙泊酚 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]