瑞马唑仑复合全身麻醉对胸腔镜肺癌根治术老年患者血流动力学、术后镇痛镇静、肝肾功能及安全性的影响  

Effects of General Anesthesia with Remimazolam on Hemodynamics,Postoperative Analgesia and Sedation,Liver and Kidney Function and Safety in Elderly Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

作　　者：赵舒 邱士超 赵明强 ZHAO Shu;QIU Shichao;ZHAO Mingqiang(Qingdao University School of Medicine,Qingdao,Shandong 266071,China;Department of Anesthesiology,Zaozhuang Municipal Hospital,Zaozhuang,Shandong 277000,China;Department of Anesthesiology and Perioperative Medicine,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266071,China)

机构地区：[1]青岛大学医学院,山东青岛266071 [2]枣庄市立医院麻醉科,山东枣庄277000 [3]康复大学青岛中心医院麻醉与围术期医学科,山东青岛266071

出　　处：《临床误诊误治》2025年第8期80-84,共5页Clinical Misdiagnosis & Mistherapy

基　　金：2022年度山东省医学会镇痛镇静-麻醉优化专项课题(YXH2022ZX05277)。

摘　　要：目的探讨瑞马唑仑复合全身麻醉在胸腔镜肺癌根治术(RRPC)老年患者中的应用效果。方法选取2022年3月至2023年9月行胸腔镜RRPC老年患者87例,采用随机数字表法分2组。观察组45例予瑞马唑仑复合全身麻醉,对照组42例予咪达唑仑复合全身麻醉。比较2组手术麻醉指标,麻醉诱导前即刻(T1)、插管后即刻(T2)、手术40 min时(T3)、拔管前即刻(T4)平均动脉压(MAP)及心率(HR)变化,术后2、4、6、12 h Steward苏醒评分,术后6、12、24、48 h疼痛视觉模拟评分法(VAS)评分,术后12 h肝肾功能指标[丙氨酸转氨酶、天冬氨酸转氨酶(AST)、白蛋白(ALB)、血肌酐(Scr)、尿素(BUN)]水平,并统计麻醉不良反应及并发症。结果2组舒芬太尼总给药量低于对照组(P<0.01)。观察组T2、T3、T4时MAP均低于T1时(P<0.05),除T1、T4时HR比较无差异,余时点与T1时比较差异均有统计学意义(P<0.05);对照组T2、T3、T4时MAP低于T1时,HR高于T1时(P<0.05)。观察组T2、T3、T4时MAP、HR波动小于对照组(P<0.05,P<0.01)。观察组术后2、4、6 h Steward苏醒评分显著高于对照组(P<0.01)。术后6 h观察组疼痛VAS评分低于对照组(P<0.01)。观察组术后12 h AST、ALB、Scr、BUN水平显著低于对照组(P<0.01)。观察组不良反应和并发症发生率分别为6.67%(3/45)、11.11%(5/45)均低于对照组的23.81%(10/42)、28.57%(12/42),差异有统计学意义(P<0.05)。结论瑞马唑仑复合全身麻醉应用于胸腔镜RRPC老年患者,可减轻患者围术期血流动力学波动,促进术后苏醒,减轻术后早期疼痛,保护肝肾功能,且安全性好。Objective To investigate the application effect of general anesthesia with Remimazolam in elderly patients undergoing thoracoscopic radical resection of pulmonary carcinoma(RRPC).Methods From March 2022 to September 2023,87 elderly patients undergoing thoracoscopic RRPC were selected and divided into two groups by random number table method.Forty-five patients in the observation group were given general anesthesia with Remimazolam,and 42 patients in the control group were given general anesthesia with Midazolam.The surgical anesthesia-related indicators,changes of mean arterial pressure(MAP)and heart rate(HR)immediately before anesthesia induction(T1),immediately after intubation(T2),at 40 min after operation(T3),and immediately before extubation(T4)were compared between the two groups.The Steward recovery score at 2,4,6,and 12 h after operation was compared between the two groups.The visual analogue scale(VAS)pain score at 6,12,24,48 h after operation,the levels of liver and kidney function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),serum creatinine(Scr),blood urea nitrogen(BUN)]at 12 h after operation,and the adverse reactions and complications caused by anesthesia were recorded.Results The total dosage of Sufentanil in the two groups was lower than that in the control group(P<0.01).In the observation group,MAP at T2,T3 and T4 was lower than that at T1(P<0.05).Except HR at T1 and T4 that showed no significant difference,there was significant difference between the other time points and T1(P<0.05).In the control group,MAP at T2,T3 and T4 was lower than that at T1,while HR was higher than that at T1(P<0.05).The fluctuations of MAP and HR at T2,T3 and T4 in the observation group were smaller than those in the control group(P<0.05,P<0.01).Steward recovery scores at 2,4 and 6 h after operation in the observation group were significantly higher than those in the control group(P<0.01).The VAS pain score of the observation group was lower than that of the control group at 6 h aft

关 键 词：肺肿瘤 胸腔镜肺癌根治术 老年人 瑞马唑仑 全身麻醉 平均动脉压 疼痛 丙氨酸转氨酶 天冬氨酸转氨酶 药物毒性 

分 类 号：R734.2[医药卫生—肿瘤]