瑞马唑仑对围术期老年患者椎管内麻醉镇静应激和炎症反应的影响  

Effects of remimazolam on stress and inflammatory responses in elderly patients undergoing intraspinal anesthesia sedation during the perioperative period

作　　者：郭永梅 张茹茹 王立敏 胡旭兰 张玮玮[1] GUO Yongmei;ZHANG Ruru;WANG Limin;HU Xulan;ZHANG Weiwei(Department of Anesthesia and Surgery,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院麻醉手术科,山西太原030012

出　　处：《大连医科大学学报》2024年第5期405-409,共5页Journal of Dalian Medical University

基　　金：山西省基础研究计划项目(202103021223425);山西省医师协会医师临床科研项目(YSXH-RF2022MZ001);山西省科技创新人才团队专项资助项目(202304051001045)。

摘　　要：目的探讨瑞马唑仑对围术期老年患者椎管内麻醉镇静应激和炎症反应的影响。方法选择2024年2-5月在山西省人民医院行椎管内麻醉的老年患者84例,按随机数字表分为两组,瑞马唑仑组(R组)和丙泊酚组(P组),每组42例。所有患者行蛛网膜下隙阻滞,在麻醉平面固定并且血流动力学平稳后进行镇静。镇静诱导:R组静脉注射瑞马唑仑5~10 mg,P组静脉注射丙泊酚0.5~0.8 mg·kg^(-1),给药时间1 min(±5 s)。均待患者改良镇静/警觉(MOAA/S)评分达3分后,开始镇静维持。镇静维持:R组静脉泵注起始剂量为0.2 mg·kg^(-1)·h^(-1),P组为2 mg·kg^(-1)·h^(-1)。手术结束后停止输注瑞马唑仑、丙泊酚。收集患者椎管内麻醉前(T0)、术毕(T1)外周静脉血各2 mL,离心分离血清,采用ELISA法测量血清NA、TNF-α。收集患者T0、术后24小时(T2)外周血白细胞(WBC)计数检测结果。记录镇静期间、麻醉恢复室(PACU)期间不良反应发生情况。结果最终81例完成本试验,其中R组41例,P组40例。与T0比较,P组、R组T1时的血清NA、TNF-α浓度升高,差异有统计学意义(P<0.05)。与P组比较,R组T1时的血清NA、TNF-α浓度较低,差异有统计学意义(P<0.05)。与T0比较,P组、R组T2外周血WBC计数升高,差异有统计学意义(P<0.05)。与P组比较,R组低血压、呼吸抑制、注射痛的发生率较低,差异有统计学意义(P<0.05);心率减慢、呛咳的发生率两组间差异无统计学意义(P>0.05)。R组患者不良反应发生率7.3%,低于P组患者的25.0%(P<0.05)。结论在围术期老年患者椎管内麻醉镇静过程中,瑞马唑仑可以减少应激反应、抑制炎症因子,使患者在围术期更加安全与舒适。Objective To investigate the effects of remimazolam on stress and inflammatory responses in perioperative elderly patients undergoing intraspinal anesthesia.Methods A total of 84 elderly patients who underwent intraspinal anesthesia at Shanxi Provincial People's Hospital from February 2024 to May 2024 were selected and randomly divided into two groups:remimazolam group(group R)and propofol group(group P),42 cases in each group.All patients received subarachnoid block and sedation was initiated after the anesthesia plane was stabilized and hemodynamics remained stable.Sedation induction:group R received an intravenous injection of remimazolam 5-10 mg,and group P received an intravenous injection of propofol 0.5-0.8 mg/kg,with a drug administration time of 1 min(±5 s).Sedation was maintained when the MOAA/S score of all patients reached 3 points.Sedation maintenance:The initial dose of intravenous infusion in group R was 0.2 mg•kg^(−1)•h^(−1),and in group P,it was 2 mg•kg^(−1)•h^(−1).The infusion of remimazolam and propofol was stopped after the surgery.Peripheral venous blood(2 mL)was collected from the patients before spinal anesthesia(T0)and after the surgery(T1),and serum was separated by centrifugation.Serum levels of norepinephrine(NA)and tumor necrosis factor-alpha(TNF-α)were measured using ELISA.The peripheral blood leukocyte count(WBC)was collected from the patients at 24 hours after surgery(T2).Adverse reactions during sedation and PACU were recorded.Results A total of 81 patients completed the trial,including 41 in group R and 40 in group P.Compared with T0,serum NA and TNF-αlevels increased at T1 in both groups P and R(P<0.05).Compared with group P,serum NA and TNF-αlevels at T1 were lower in group R(P<0.05).Compared with T0,WBC counts at T2 increased in both groups P and R(P<0.05).Compared with group P,the incidence of hypotension,respiratory depression and injection pain in group R was lower(P<0.05).There was no significant difference in the incidence of bradycardia or coughing bet

关 键 词：苯二氮卓类 老年人 应激 炎症 

分 类 号：R614[医药卫生—麻醉学]