不同剂量瑞马唑仑对肝癌根治手术患者麻醉镇痛效果及血流动力学的影响  

Impact of different doses of remimazolam on anesthetic analgesic effects and hemodynamics in patients undergoing radical hepatectomy

作　　者：周翼 王晓东 靳涛 王建华 兰基山[1] 齐少霞[1] Zhou Yi;Wang Xiao-dong;Jin Tao;Wang Jian-hua;Lan Ji-shan;Qi Shao-xia(First Department of Anesthesiology,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061000,China;Department of Anesthesiology,Orthopedic Area,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院麻醉一科,沧州061000 [2]河北省沧州中西医结合医院骨科院区麻醉科,沧州061000

出　　处：《中国药物应用与监测》2025年第1期96-100,共5页Chinese Journal of Drug Application and Monitoring

基　　金：河北省2022年度医学科学研究课题计划项目(20220692)。

摘　　要：目的观察不同剂量瑞马唑仑对肝癌根治术患者麻醉镇痛效果及血流动力学的影响。方法选取于河北省沧州中西医结合医院2022年1月至2023年12月行肝癌根治术的90例患者作为研究对象,根据随机数字表法分为A组(n=30)、B组(n=30)、C组(n=30),3组患者均采用瑞马唑仑复合舒芬太尼进行麻醉诱导,其中A组患者使用瑞马唑仑的剂量为0.1 mg·kg^(-1),B组患者为0.15 mg·kg^(-1),C组患者为0.2 mg·kg^(-1)。比较3组患者的麻醉诱导及镇静效果、诱导开始时(T_(0))、BIS值≤60时(T_(1))及气管插管后(T_(2))血流动力学指标[心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))]、术后1 h、12 h、24 h的视觉模拟疼痛评分(VAS)及不良反应情况。结果A组麻醉起效时间长于B组和C组[(73.45±15.06)s vs(61.28±10.46)s vs(50.43±6.35)s],差异有统计学意义(F=31.634,P<0.001);镇静有效率:A组<B组<C组(70.00%vs 96.67%vs 100.00%)(χ^(2)=16.425,P<0.001)。T_(0)~T_(2)时,3组患者的HR值逐渐上升,而MAP值及SpO_(2)值均先下降后再上升,差异有统计学意义(F=109.716、78.389、213.786,P<0.001)。T_(0)、T_(1)、T_(2)时,3组患者的HR值及MAP值差异无统计学意义(F=0.014、0.022,P>0.05)。T_(1)、T_(2)时,A组患者的SpO_(2)值最低,C组患者为最高(F=7.059,P<0.05)。术后1~24 h,3组患者的VAS疼痛评分逐渐上升,且不同时间点A组患者的VAS疼痛评分均为最高,而C组最低,差异有统计学意义(F=1197.006、48.542、2.718,P<0.05)。A组总不良反应率3.33%,B组总不良反应率6.67%,C组总不良反应率为10.00%,3组差异无统计学意义(χ^(2)=3.108,P>0.05)。结论瑞马唑仑用于肝癌根治手术的麻醉诱导时,随着剂量的增加,起效时间越短,且镇静效果越好;但不同剂量的瑞马唑仑对患者术中的血流动力学影响及术后不良反应差异较小,其中0.15 mg·kg^(-1)为最佳剂量。Objective To investigate the effect of different doses of remimazolam on hemodynamics during anaesthetic induction in invalids undergoing radical hepatectomy.Methods A total of 90 patients undergoing radical resection of liver cancer in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to December 2023 were selected as the research subjects and divided into group A(n=30),group B(n=30)and group C(n=30)according to the random number table method.Remimazolam was used in combination with sufentanil for anesthesia induction in all the threee groups.The dose of remimazolam used was 0.1 mg·kg^(-1) in group A,0.15 mg·kg^(-1) in group B and 0.2 mg·kg^(-1) in group C.The anesthesia induction and sedation effects,hemodynamic indicators(heart rate(HR),mean arterial pressure(MAP)and pulse oximetry(SpO_(2)))at the beginning of induction(T_(0)),when BIS value≤60(T_(1))and after tracheal intubation(T_(2)),visual analogue score(VAS)at 1 h,12 h,and 24 h after surgery,and adverse reactions were compared among the three groups.Results The onset of anesthesia in group A was longer than that in groups B and C((73.45±15.06)s vs(61.28±10.46)s vs(50.43±6.35)s),and the difference was statistically significant(F=31.634,P<0.001).Sedation efficient was increased in order from group A to group C(70.00%vs 96.67%vs 100.00%)(χ^(2)=16.425,P<0.001).At T_(0)~T_(2),HR values were gradually increased in all the three groups,while MAP values and SpO_(2) values decreased first and then increased,showing statistical significance(F=109.716,78.389,213.786,P<0.001).At T_(0),T_(1) and T_(2),there was no significant difference in HR and MAP values among the three groups(F=0.014,0.022,P>0.05).At T_(1) and T_(2),the SpO_(2) value in group A was the lowest,and that in group C was the highest(F=7.059,P<0.05).From 1 h to 24 h after surgery,the VAS scores were gradually increased in all the three groups.At different time points,the VAS scores in group A were the highest,while those in group C were the lowest.The di

关 键 词：瑞马唑仑 舒芬太尼 肝癌 麻醉诱导 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]