瑞马唑仑在单侧双通道内镜下髓核摘除手术患者中的应用效果  

Application effect of remimazolam in patients with unilateral biportal endoscopic discectomy

作　　者：樊超 张明敏 俞江萍 项杰 FAN Chao;ZHANG Mingmin;YU Jiangping;XIANG Jie(Department of Anesthesiology,Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology,Hangzhou 311400,China;Department of Joint,Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology,Hangzhou 311400,China)

机构地区：[1]杭州市富阳中医骨伤医院麻醉科,杭州311400 [2]杭州市富阳中医骨伤医院关节科,杭州311400

出　　处：《药学前沿》2025年第4期595-600,共6页China Pharmacist

基　　金：浙江省中医药科技计划项目(2024ZL820)。

摘　　要：目的探讨不同剂量瑞马唑仑对单侧双通道内镜下髓核摘除(UBED)手术患者的应用效果。方法回顾性收集2021年1月—2024年7月杭州市富阳中医骨伤医院关节科接受UBED手术的患者资料,根据麻醉方案,将患者分为低剂量组(舒芬太尼+0.2μg/kg瑞马唑仑麻醉)、中剂量组(舒芬太尼+0.3μg/kg瑞马唑仑麻醉)、高剂量(舒芬太尼+0.4μg/kg瑞马唑仑麻醉)。比较3组患者拔管时间、麻醉后监测治疗室(PACU)停留时间;入室后(T1)、打磨小关节(T2)、髓核摘除(T3)、术毕(T4)时心率(HR)、平均动脉压(MAP)、呼吸频率(RR);术前、术后24 h血清神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β(S100β)水平;不良反应发生率。结果共纳入80例患者,低、中剂量组各27例,高剂量组26例。高剂量组麻醉达标时间显著低于低、中剂量组(P<0.05),中剂量组麻醉达标时间显著低于低剂量组(P<0.05);高剂量组拔管时间、PACU停留时间显著高于低、中剂量组(P<0.05),中剂量组拔管时间、PACU停留时间显著高于低剂量组(P<0.05)。高剂量组患者T2、T3、T4时HR、MAP、RR均显著低于低剂量组(P<0.05),但与中剂量组HR、MAP、RR比较差异无统计学意义(P>0.05)。术后24 h 3组患者NSE、S100β水平均较术前显著上升(P<0.05),但3组间差异无统计学差异(P>0.05)。3组间麻醉不良反应发生率差异无统计学意义(P>0.05)。结论瑞马唑仑用于UBED手术患者镇静效果理想,0.3μg/kg剂量在麻醉速度与血流动力学稳定性间取得平衡,但PACU停留时间仍显著长于0.2μg/kg剂量,临床应用需个体化选择剂量。Objective To explore the effect of different doses of remimazolam on patients undergoing unilateral biportal endoscopic discectomy(UBED).Methods The data of patients who underwent UBED in the Department of Joint,Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology from January 2021 to July 2024 were retrospectively collected.According to the anesthesia scheme,the patients were divided into a low-dose group(sufentanil+0.2μg/kg remimazolam anesthesia),a medium-dose group(sufentanil+0.3μg/kg remimazolam anesthesia),and a high-dose group(sufentanil+0.4μg/kg remimazolam anesthesia).The three groups were compared in terms of extubation time,post-anesthesia cure unit(PACU)stay time;heart rate(HR),mean arterial pressure(MAP)and respiratory rate(RR)after admission(T1),while grinding of facet joints(T2),nucleus pulposus removal(T3),and completion of surgery(T4),serum neuron-specific enolase(NSE)and S100 calcium-binding proteinβ(S100β)levels before and 24 hours after surgery,and the incidence of adverse reactions.Results A total of 80 patients were included,including 27 patients in the low-dose group,27 patients in the medium-dose group,and 26 patients in the high-dose group.The time to achieve anesthesia in the high-dose group was significantly less than that in the low-dose and medium-dose group(P<0.05),and the time to achieve anesthesia in the medium-dose group was significantly less than that in the low-dose group(P<0.05);the time to extubation and PACU stay time in the high-dose group was significantly more than that in the low-dose and medium-dose group(P<0.05),and the time to extubation and PACU stay time in the medium-dose group was significantly more than that in the low-dose group(P<0.05).The HR,MAP,and RR of the high-dose group were significantly lower than those of the low-dose group at T2,T3,and T4(P<0.05),but there was no significant difference in HR,MAP,and RR between the high-dose group and the mediumdose group(P>0.05).The NSE and S100βlevels of the three groups increased significantly 24 hours

关 键 词：瑞马唑仑 单侧双通道内镜下髓核摘除手术 血清神经元特异性烯醇化酶 麻醉后监测治疗室停留时间 麻醉不良反应 

分 类 号：R9711[医药卫生—药品]