不同剂量瑞马唑仑全麻诱导对老年腹部手术患者气管插管应激反应、血流动力学及肌阵挛、躁动的影响  

Effects of general anesthesia induction using remimazolam at various doses on stress response during tracheal intubation,hemodynamics,myoclonus and agitation in elderly patients after abdominal surgery

作　　者：李洋 李志英 董学义 杨艳兵 王晓丽 LI Yang;LI Zhiying;DONG Xueyi;YANG Yanbing;WANG Xiaoli(Department of Anesthesiology,Zibo 148th Hospital of China Rongtong Medical Group,Shandong Zibo 255300,China;Department of Drug and Equipment,Zibo 148th Hospital of China Rongtong Medical Group,Shandong Zibo 255300,China)

机构地区：[1]中国融通医疗集团淄博一四八医院麻醉科,山东淄博255300 [2]中国融通医疗集团淄博一四八医院药械科,山东淄博255300

出　　处：《中国医院药学杂志》2025年第3期303-307,共5页Chinese Journal of Hospital Pharmacy

摘　　要：目的:分析不同剂量瑞马唑仑全麻诱导对老年腹部手术患者气管插管应激反应、血流动力学及肌阵挛和躁动的影响。方法:选取2022年6月至2023年6月淄博一四八医院收治的老年腹部手术患者90例,按随机数表法分为A组、B组和C组,每组30例。3组患者均行瑞马唑仑进行全麻诱导,剂量分别为0.2、0.3、0.4 mg·kg^(-1),其余麻醉方式相同。比较3组患者T_(0)(诱导开始时)、T_(1)(初次BIS≤60时)、T_(2)(气管插管后)及T_(3)(拔管后30 min)时刻的应激反应[肾上腺素(E),去甲肾上腺素(NE)和血清皮质醇(Cor)]、血流动力学指标[心率(HR)、收缩压(SBP)及舒张压(DBP)]及肌阵挛、躁动等不良事件发生情况。结果:3组Cor、E及NE时点、组间、交互比较均存在显著差异(P<0.05);T_(3)时刻C组Cor、E及NE均小于A组、B组(P<0.05);B组Cor、E及NE均小于A组(P<0.05);3组HR、SBP及DBP组间、交互比较差异无统计学意义(P>0.05);时间点比较差异有统计学意义(P<0.05);3组肌阵挛发生率比较差异无统计学意义(P>0.05);A组患者躁动发生率3.33%、B组为6.67%,低于C组的23.33%(P<0.05)。结论:0.2、0.3、0.4 mg·kg^(-1)3种剂量瑞马唑仑麻醉诱导均能够有效维持老年腹部手术血流动力学稳定性,但0.2、0.3 mg·kg^(-1)静脉注射瑞马唑仑麻醉诱导可减少患者躁动发生率,0.3、0.4 mg·kg^(-1)瑞马唑仑能够有效抑制患者气管插管应激反应。综合考虑0.3 mg·kg^(-1)剂量瑞马唑仑更能够兼顾安全性。OBJECTIVE To analyze the effects of general anesthesia induction using remimazolam at various doses on stress response during tracheal intubation,hemodynamics,myoclonus and agitation in elderly patients after abdominal surgery.METHODS A total of 90 elderly patients undergoing abdominal surgery in Zibo 148th Hospital between June 2022 and June 2023 were enrolled.According to random number table method,they were randomly divided into group A,group B and group C,with 30 cases in each group.All the three groups were given general anesthesia induction using remimazolam(0.2,0.3,0.4 mg·kg^(-1)),and the anesthesia methods were the same in the three groups.At T_(0)(at the beginning of induction),T_(1)[the first time of bispectral index(BIS)≤60],T_(2)(after tracheal intubation)and T_(3)(30 min after extubation),stress response indexes[epinephrine(E),norepinephrine(NE),serum cortisol(Cor)],hemodynamics indexes[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)]and the occurrence of adverse events(myoclonus,agitation)were compared among the three groups.RESULTS There were significant differences in the time point,inter-group and interaction dimensions of Cor,E and NE among the three groups(P<0.05).At T_(3),Cor,E and NE in group C were significantly lower than those in group A and group B(P<0.05),and they were significantly lower in group B than group A(P<0.05).There were no significant differences in the between-group and interaction dimensions of HR,SBP and DBP among the three groups(P>0.05),but there were significant differences in the time dimension(P<0.05).There was no significant difference in the incidence of myoclonus among the three groups(P>0.05).The incidence of agitation was 3.33%in group A and 6.67%in group B,which was significantly lower than that of 23.33%in group C(P<0.05).CONCLUSION General anesthesia induction using remimazolam at various doses(0.2,0.3 mg·kg^(-1),0.4 mg·kg^(-1))can effectively maintain hemodynamics stability in elderly patients after abdominal surgery.However,intr

关 键 词：腹部手术 瑞马唑仑 应激反应 血流动力学 肌阵挛 

分 类 号：R969.4[医药卫生—药理学]