文章摘要
不同剂量瑞马唑仑用于宫腔镜手术的安全性和有效性
Safety and efficacy of different doses of remimazolam in hysteroscopic surgery
  
DOI：10.12089/jca.2022.04.002
中文关键词: 瑞马唑仑  丙泊酚  宫腔镜  无痛诊疗
英文关键词: Remimazolam  Propofol  Hysteroscopy  Painless diagnosis and treatment
基金项目:湖南省教育厅科研项目（20C1114）；湖南省卫健委科研项目（202104111828）
作者单位E-mail
魏来 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
李洁琼 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
洪谭浩 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
谭思由 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
黄倩 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
罗雯 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
苏颖颖 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
唐轶珣 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
孔高茵 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科  
陈文雁 410005,长沙市,湖南省人民医院（湖南师范大学附属第一医院）麻醉科 chinanes@126.com 
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中文摘要:
      
目的 比较三种剂量瑞马唑仑和丙泊酚用于宫腔镜手术的安全性和有效性。
方法 选择择期全麻下行宫腔镜手术患者180例，年龄18~60岁，ASA Ⅰ—Ⅲ级。采用随机数字表法将其分为四组：C组、R1组、R2组和R3组，每组45例。所有患者静脉注射舒芬太尼5 μg后，C组静脉注射丙泊酚1～2 mg/kg进行麻醉诱导，待改良警觉/镇静评分（MOAA/S）为0分后予以5 mg·kg-1·h-1静脉泵注维持；R1组、R2组和R3组均静脉泵注瑞马唑仑6 mg·kg-1·h-1进行麻醉诱导，MOAA/S为0分后，R1组、R2组和R3组分别调整剂量为0.5、1.0和1.5 mg·kg-1·h-1术中维持。记录镇静起效时间、术中补救镇痛例数以及苏醒时间。记录入室平静时（T0）、麻醉诱导后MOAA/S为0分时（T1）、术中SBP最低时（T2）、麻醉苏醒（T3）后HR、SBP和DBP。记录术中知晓、体动、多巴胺使用例数、呼吸抑制、肌震颤、头痛、注射痛、瘙痒、恶心、呕吐、咳嗽、出汗、寒战和苏醒后眩晕等不良事件的发生情况。
结果 R1组、R2组和R3组镇静起效时间明显长于C组（P＜0.05），R2组、R3组术中补救镇痛率明显低于R1组（P＜0.05），R2组和R3组苏醒时间明显长于C组和R1组（P＜0.05）。T1时R1组、R3组HR明显快于C组（P＜0.05）。T1、T2时R1组、R2组和R3组SBP和DBP均明显高于C组（P＜0.05）。R1组术中体动发生率明显高于R2组、R3组（P＜0.05），R1组、R2组和R3组术中多巴胺使用率和注射痛发生率明显低于C组（P＜0.05）。
结论 以瑞马唑仑6 mg·kg-1·h-1静脉诱导、1.0 mg·kg-1·h-1麻醉维持应用于宫腔镜手术时相对于应用丙泊酚对循环系统影响更小，注射痛发生率更低，可安全、有效地应用于此类手术患者。
英文摘要:
      
ObjectiveTo evaluate the efficacy and safety of different doses of remimazolam versus propofol in patients undergoing hysteroscopic surgery.

Methods A total of 180 patients, aged 18-60 years, ASA physical status Ⅰ-Ⅲ, scheduled to hysteroscopic surgery under intravenous general anesthesia were divided into four groups using a random number table method: group C, groups R1, R2, and R3, 45 patients in each group. All patients were intravenously injected with sufentanil 5 μg. Group C was induced by the intravenous dose of propofol 1-2 mg/kg, then maintained by propofol 5 mg·kg-1·h-1 when modified observer's assessment of alertness/sedation (MOAA/S) was zero. The groups R1, R2, R3 were induced by intravenous remimazolam 6 mg·kg-1·h-1. After the MOAA/S score was zero, the maintenance doses of remimazolam of groups R1, R2, R3 were respectively adjusted to 0.5, 1.0, gand 1.5 mg·kg-1·h-1. The onset time of sedation, the number of drug remedy cases and recovery time of sedatives were recorded. HR, SBP, DBP were recorded after entering the room (T0), when MOAA/S was zero after anesthesia induction (T1), when SBP was the lowest during operation (T2), and after awakening (T3). The occurrence of adverse events such asintraoperative awareness, body movement, number of cases of using dopamine, respiratory depression, muscle tremor, headache, injection pain, pruritus, nausea, vomiting, cough, sweating, chills and dizziness after awakening were recorded.
Results The onset time of sedation in groups R1, R2, R3 were significantly longer than that in group C (P < 0.05), and the rate of drug remedy in groups R2 and R3 were significantly lower than that in group R1 (P < 0.05), and the recovery time in groups R2 and R3 was significantly longer than that in groups C and R1 (P < 0.05). and HR in groups R1 and R3 were significantly faster than that in group C at T1(P<0.05). SBP and DBP in groups R1, R2 and R3 were significantly higher than those in group C at T1 and T2 (P < 0.05). The incidence of intraoperative body movement in group R1 was significantly higher than that in groups R2 and R3 (P < 0.05), and the incidence of dopamine utilization and injection pain in groups R1, R2 and R3 were significantly lower than those in group C (P < 0.05).
Conclusion Intravenous induction with remimazolam 6 mg·kg-1·h-1 and anesthesia maintenance with remimazolam 1.0 mg·kg-1·h-1 have less impact on the circulatory system and lower incidence of injection pain compared with propofol. Remimazolam can be safely and effectively applied to hysteroscopic surgery.
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