甲苯磺酸瑞马唑仑在腹腔镜胆囊切除术中的应用效果及安全性分析

Application effect and safety analysis of remazolam toluenesulfonate in laparoscopic cholecystectomy

摘要:

目的 探讨甲苯磺酸瑞马唑仑应用于腹腔镜胆囊切除术(LC)中的安全性及效果。方法 采用随机数字表法，将2023年6月至2024年6月凉山彝族自治州第一人民医院收治的行LC治疗老年患者80例分为试验组与对照组，两组分别采用甲苯磺酸瑞马唑仑与丙泊酚进行麻醉诱导与维持，比较两组患者术中镇静效果、麻醉恢复[包括拔管时间、睁眼时间、呼吸恢复时间、麻醉复苏室(PACU)滞留时间、苏醒期Ramsay评分]、围手术期不同时间点平均动脉压(MAP)及心率(HR)、脑电双频谱指数(BIS)水平，统计两组麻醉药物使用剂量与麻醉不良反应。结果 两组患者镇静成功率均为100%,患者均无术中知晓及严重并发症。试验组意识消失时间、睫毛反射消失时间及BIS降至60时间、拔管时间、睁眼时间、呼吸恢复时间、PACU滞留时间均短于对照组，苏醒期Ramsay评分高于对照组(P<0.05)。两组诱导完成即刻(T1)、气管插管后(T2)MAP及HR水平均较同组麻醉诱导前(T0)下降(P<0.05),气管插管后3 min(T3)两组MAP水平均恢复至同组T0水平，但差异无统计学意义(P>0.05),HR水平均高于同组T0水平(P<0.05);两组T1、T2、T3的BIS水平均较同组T0下降(P<0.05),且保持平稳趋势；试验组患者T1、T2的MAP及HR水平均高于对照组(P<0.05),两组不同时间点BIS水平差异无统计学意义(P>0.05)。对照组低血压及注射痛发生率高于试验组(P<0.05)。结论 甲苯磺酸瑞马唑仑应用于老年LC的麻醉诱导与维持，可获得良好的镇痛、镇静效果，患者术后苏醒快，不良反应少。

Abstract:

Objective Toexplorethesafetyandefficacyofremimazolamtosylateinlaparoscopiccholecystectomy (LC).Methods Atotalof80elderlypatientsscheduledforLCintheFirstPeople'sHospitalofLiangshanYiAutonomous PrefecturefromJune2023toJune2024 wereselectedanddividedintotheexperimentalgroupandthecontrolgroupby randomnumbertable method.Thetwogroupsreceivedremimazolamtosylateandpropofolforanesthesiainductionand maintenance,respectively.Theintraoperativesedativeeffect,anesthesiarecovery [extubationtime,eyeopeningtime, respiratoryrecoverytime,postanesthesiacareunit(PACU)retentiontime,andRamsayscoreduringrecovery]aswellas meanarterialpressure (MAP),heartrate (HR)andbispectralindex (BIS)atdifferentperioperativetimepointswere comparedbetweengroups.Thedosagesofanestheticdrugsandadversereactionsofanesthesiawerecounted.Results The successrateofsedationinbothgroupswas100%.Therewerenointraoperativeawarenessandseriouscomplicationsinboth groups.Thetimeoflossofconsciousness,disappearancetimeofeyelashreflex,timeofBISfallingto60,extubationtime, eyeopeningtime,respiratoryrecoverytimeandPACUretentiontimeintheexperimentalgroupwereshorterthanthosein thecontrolgroup,andtheRamsayscoreduringrecoverywashigherthanthatinthecontrolgroup(P<0.05).TheMAP andHRatinductioncompletion(T1)andaftertrachealintubation(T2)inbothgroupswerereducedcomparedwiththose beforeanesthesiainduction(T0)(P<0.05).At3minaftertrachealintubation(T3),theMAPinbothgroupsreturnedto thelevelatT0,butthedifferencebetweengroupswasnotstatisticallysignificant(P>0.05),whiletheHRwashigherthan thatatT0(P<0.05).TheBISatT1,T2andT3inbothgroupswaslowerthanthatatT0(P<0.05),andmaintaineda stabletrend.TheMAPandHRatT1andT2intheexperimentalgroupwerehigherthanthoseinthecontrolgroup(P<0.05). TherewasnosignificantdifferenceinBISlevelbetweenthetwogroupsatdifferenttimepoints(P>0.05).Theincidence ratesofhypotensionandinjectionpaininthecontrolgroupwerehigherthanthoseintheexperimentalgroup (P<0.05). Conclusion Theapplication ofremimazolam tosylateintheanesthesiainduction and maintenancein elderly patients undergoingLCcanobtaingoodanalgesicandsedativeeffects,fastpostoperativerecoveryandfewadversereactions.