不同诱导剂量甲苯磺酸瑞马唑仑在急性胆囊炎患者腹腔镜手术全麻诱导中的应用对比  

Comparison of the Application of Different Induction Doses of Remimazolam Tosilate in the Induction of General Anesthesia for Patients with Acute Cholecystitis undergoing Laparoscopic Surgery

作　　者：张艳霞[1] 尚美娟 许少华[1] Zhang Yanxia;Shang Meijuan;Xu Shaohua(Department of Anesthesiology,Zhengzhou first people's Hospital Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第一人民医院麻醉科,河南郑州450000

出　　处：《哈尔滨医药》2025年第2期11-14,共4页Harbin Medical Journal

基　　金：河南省联合共建项目(LHGJ20210043)。

摘　　要：目的探究急性胆囊炎腹腔镜手术患者,实施不同诱导剂量甲苯磺酸瑞马唑仑全麻诱导的价值。方法本研究以93例拟行腹腔镜手术的患者为研究对象,按随机表法将他们分为R1、R2和R3三组,每组31例。进行麻醉诱导时:三组患者在30s静脉内注射0.20、0.25、0.30mg/kg的甲苯磺酸瑞马唑仑,并在此基础上用0.4mg/kg舒芬太尼加0.6mg/kg罗库溴铵,使之具备了气管插管的能力;麻醉维持采用0.5mg/(kg·h)甲苯磺酸瑞马唑仑、6~12μg/(kg·h)瑞芬太尼以及1%的七氟醚。通过比较患者的镇静生效状况,记录在各个时间点的血流动力学及应激反应指标变化,麻醉药物使用量,患者苏醒状况,以及麻醉诱导期间不良事件的出现情况。结果R3组睫毛反射消失时间、镇静起效时间短于R1组、R2组,R2组镇静起效时间短于R1组(P<0.05)。在给予不同剂量的甲苯磺酸瑞马唑仑进行麻醉诱导的患者中,于麻醉开始前(T0)、气管插管时(T1)、手术开展5min(T2)及手术完成时(T3)的HR与MAP各项指标对比,差异无统计学意义(P>0.05)。R3组患者在手术结束及术后6h血清中的NE和Cor浓度均低于R1、R2组(P<0.05)。此外,R3组在手术过程中使用的舒芬太尼和瑞芬太尼剂量亦低于R1组和R2组(P<0.05)。不同诱导剂量甲苯磺酸瑞马唑仑组患者苏醒情况、不良反应总发生率比较差异无统计学意义(P>0.05)。结论0.25、0.30 mg/kg剂量的甲苯磺酸瑞马唑仑均可安全有效地用于急性胆囊炎患者腹腔镜手术全麻诱导中;与0.25 mg/kg剂量比较,0.30 mg/kg剂量镇静起效时间更短,可实现术中麻醉药物用量的减少,减轻机体应激反应,值得推广。Objective To investigate the efficacy and safety of different induction doses of remimazolam tosilate for general anesthesia in patients with acute cholecystitis undergoing laparoscopic surgery.Methods A total of 93 patients scheduled for laparoscopic surgery were randomly allocated into three groups(R1,R2,and R3),each comprising 31 patients.Anesthesia was induced with intravenous remimazolam tosilate at doses of 0.20 mg/kg,0.25 mg/kg,and 0.30 mg/kg over 30 seconds,respectively,followed by sufentanil 0.4μg/kg and rocuronium 0.6 mg/kg for endotracheal intubation.Anesthesia maintenance was achieved using a continuous infusion of remimazolam tosilate at 0.5 mg/(kg·h),remifentanil at 6-12μg/(kg·h),and sevoflurane at 1%.The effectiveness of sedation,hemodynamic parameters,stress response indices,anesthetic drug consumption,patient recovery status,and incidence of adverse events during anesthesia induction were recorded and compared among the groups.Results The time to loss of eyelash reflex and onset of sedation were significantly shorter in group R3 compared to groups R1 and R2,and in group R2 compared to group R1(P<0.05).There were no significant differences in heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T0),at tracheal intubation(T1),5 minutes post-induction(T2),and at the end of surgery(T3)across the groups(P>0.05).Serum concentrations of norepinephrine(NE)and cortisol(Cor)were lower in group R3 than in groups R1 and R2 at the end of surgery and 6 hours postoperatively(P<0.05).Additionally,the intraoperative doses of sufentanil and remifentanil were significantly lower in group R3 compared to groups R1 and R2(P<0.05).No significant differences were observed in recovery times or overall incidence of adverse reactions between the groups(P>0.05).Conclusion Both 0.25 mg/kg and 0.30 mg/kg remimazolam tosilate are safe and effective for inducing general anesthesia in patients with acute cholecystitis undergoing laparoscopic surgery.However,the 0.30 mg/kg dose offers advantages by shortening the on

关 键 词：全身麻醉 麻醉诱导 甲苯磺酸瑞马唑仑 急性胆囊炎 腹腔镜手术 

分 类 号：R971.2[医药卫生—药品]