摘要
目的评价瑞马唑仑用于五官科手术患者喉罩全麻诱导与维持的效果,探索可安全用于日间手术的全身麻醉新模式。方法选取2021年4月至2022年2月北京同仁医院收治的择期行喉罩全身麻醉的眼、耳、鼻科手术患者114例,采用随机数字表法分为丙泊酚组和瑞马唑仑组,每组57例。诱导开始静脉注射舒芬太尼0.2μg/kg,丙泊酚组静脉注射丙泊酚2 mg/kg,瑞马唑仑组静脉输注瑞马唑仑0.3 mg/kg,待患者意识消失后静脉注射罗库溴铵0.6 mg/kg,行喉罩置入。丙泊酚组静脉输注丙泊酚4~8 mg/(kg·h),瑞马唑仑组静脉输注瑞马唑仑1~3 mg/(kg·h)维持麻醉。术中维持脑电双频指数(BIS)值40~60。记录镇静诱导时间、意识恢复时间、喉罩拔除时间、麻醉后监测治疗室(PACU)停留时间,记录诱导前(T)、喉罩置入前(T)、喉罩置入后(T)、手术开始前(T)、停药时(T)和喉罩拔除时(T)的平均动脉压(MAP)、心率(HR);记录麻醉诱导时注射痛、术中和术后并发症的发生情况。结果两组镇静成功率为100%。瑞马唑仑组的镇静诱导时间长于丙泊酚组,诱导时注射痛、术中低血压和心动过缓的发生率低于丙泊酚组,差异有统计学意义(P<0.05);两组意识恢复时间、喉罩拔除时间、PACU停留时间、术中心动过速和术后恶心呕吐发生率比较,差异无统计学意义(P>0.05)。两组T时MAP比较,差异无统计学意义(P>0.05);两组T~T时的MAP值均低于T时,但瑞马唑仑组高于丙泊酚组,差异有统计学意义(P<0.05);两组T时HR比较,差异无统计学意义(P>0.05),瑞马唑仑组T、T时间点的HR值高于丙泊酚组,差异有统计学意义(P<0.05);丙泊酚组T~T时的HR值均低于T时,差异有统计学意义(P<0.05);瑞马唑仑组T、T、T时的HR值与T时比较,差异无统计学意义(P>0.05);两组均未见高血压和术中知晓的发生。PACU期间及术后24 h内随访,两组未见其他并发症发生。结论瑞马唑仑可安全有效地用于五官科手术患者喉罩全麻的诱导与维持,更有助于维持术中血流动力学的平稳,降低不良反应发生率。
Objective To evaluate the efficacy of Remimazolam for induction and maintenance of laryngeal mask general anesthesia in patients undergoing otorhinolaryngology surgery,and to explore a new general anesthesia model that can be safely used in day surgery.Methods A total of 114 patients of undergoing otorhinolaryngology surgery under laryngeal mask general anesthesia admitted to Beijing Tongren Hospital from April 2021 to February 2022.They were divided into Propofol group and Remimazolam group using a random number table method,with 57 cases in each group.At the beginning of induction,intravenously infusing Sufentanil 0.2μg/kg,Propofol 2 mg/kg was injected in Propofol group,Remimazolam 0.3 mg/kg was injected in Remimazolam group,Rocuronium 0.6 mg/kg was injected after the patients consciousness disappeared,laryngeal mask intubation was performed.Anesthesia was maintained by intravenously injecting Propofol 4-8 mg/(kg·h)in Propofol group and Remimazolam 1-3 mg/(kg·h)in Remimazolam group.Bispectralindexvalues(BIS)was maintained at 40-60.The time of sedation induction,recovery time of consciousness,time of laryngeal mask extubation and residence time in postanesthesia care unit(PACU)were recorded;the MAP and HR before induction(T),before laryngeal mask implantation(T),after laryngeal mask implantation(T),before surgery(T),at drug withdrawal(T)and at laryngeal mask removal(T)were recorded;the occurrence of injection pain during induction of anesthesia,intraoperative and postoperative complications were recorded.Results The success rate of sedation in both groups was 100%.The sedation induction time of Remimazolam group was higher than that of Propofol group,and the incidence of injection pain,intraoperative hypotension,and bradycardia during induction was lower than that of Propofol group,and the differences were statistically significant(P<0.05);there was no significant difference in consciousness recovery time,laryngeal mask removal time,PACU residence time,postoperative tachycardia,and postoperative nausea and vomiting between the two groups(P>0.05).There was no significant difference in MAP between the two groups at T(P>0.05);the MAP value of T-Tin both groups was lower than that of T,but that of Remimazolam group was higher than that of Propofol group,and the differences were statistically significant(P<0.05);there was no significant difference in HR between the two groups at T(P>0.05);the HR values at Tand Tin Remimazolam group were higher than those in Propofol group,and the difference was statistically significant(P<0.05);the HR value of Propofol group at T-Twas lower than that at T,and the difference was statistically significant(P<0.05);there was no significant difference between the HR values at T,T,T,and Tin Remimazolam group(P>0.05);no intraoperative hypertension and intraoperative awareness were found in both groups.No other complications were found during in PACU and within 24 h after operation.Conclusion Remimazolam can be safely and effectively used in the induction and maintenance of laryngeal mask general anesthesia in otorhinolaryngology surgery,which is more helpful to maintain the stability of hemodynamics and reduce the incidence of adverse reactions.
作者
王惠军
熊军
包音
奚春花
王古岩
WANG Huijun;XIONG Jun;BAO Yin;XI Chunhua;WANG Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing100730,China;Department of Anesthesiology,Shenzhen University General Hospital,Guangdong Province,Shenzhen518055,China)
出处
《中国医药导报》
CAS
2022年第24期115-118,123,共5页
China Medical Herald
基金
北京融合医学发展基金会资助项目(JZ-CC-20-12-30)。
关键词
瑞马唑仑
五官科手术
日间手术
全身麻醉
喉罩
Remimazolam
Otorhinolaryngology surgery
Day surgery
General anesthesia
Laryngeal mask
