文章摘要
瑞马唑仑对脊柱手术中神经电生理监测的影响
Effect of remimazolam on intraoperative neurophysiological monitoring in spinal surgery
  
DOI：10.12089/jca.2023.12.005
中文关键词: 瑞马唑仑  丙泊酚  神经电生理监测  脊柱外科
英文关键词: Remimazolam  Propofol  Neurophysiological monitoring  Spinal surgery
基金项目:
作者单位E-mail
方艳 341099,赣州市人民医院麻醉科  
尹世平 南昌大学第一附属医院麻醉科  
孙文杰 南昌大学第一附属医院麻醉科 624837074@qq.com 
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中文摘要:
      
目的 探讨瑞马唑仑对脊柱手术中神经电生理监测（IONM）的影响。
方法 选择行IONM的择期脊柱手术患者60例，男33例，女27例，年龄18～55岁，BMI 18～24 kg/m2，ASA Ⅰ—Ⅲ级。将患者随机分为两组：瑞马唑仑组（R组）和丙泊酚组（P组），每组30例。麻醉诱导及维持时R组采用瑞马唑仑，P组采用丙泊酚。记录入室时（T0）、气管插管即刻（T1）、停肌松药时（T2）、停肌松药后30 min（T3）、50 min（T4）的HR、MAP和BIS。记录首次诱发运动诱发电位（MEP）的电流强度及其波幅。记录停药后到首次诱发出MEP的时间。记录T4时体感诱发电位（SEP）和MEP的波幅及潜伏期。记录手术时间、麻醉时间、术中瑞芬太尼用量、血管活性药物使用情况、苏醒时间、拔管时间和不良反应情况。
结果 与P组比较，R组T1—T4时HR明显增快、MAP明显升高（P<0.05），首次诱发的MEP波幅明显升高（P<0.05），T4时SEP和MEP波幅明显升高、潜伏期明显缩短（P<0.05），瑞芬太尼用量明显减少（P<0.05），术中血管活性药物使用率明显降低（P<0.05），苏醒时间和拔管时间明显缩短（P<0.05）。
结论 瑞马唑仑可安全用于需行IONM的脊柱外科手术，且循环波动小、苏醒快、术后不良反应少，对SEP及MEP的影响小，有利于提高IONM的监测质量。
英文摘要:
      
Objective To investigate the effect of remimazolam on intraoperative neurophysiological monitoring (IONM) in spinal surgery.
Methods Sixty patients undergoing elective spinal surgery for IONM were selected strictly according to the criteria, 33 males and 27 females, aged 18-55 years, BMI 18-24 kg/m2, ASA physical status Ⅰ-Ⅲ. The patients were randomly divided into two groups: remimazolam group (group R) and propofol group (group P), 30 patients in each group. Remimazolam was used in group R and propofol was used in group P during induction and maintenance of anesthesia. HR, MAP, and BIS values were recorded when patients entered the room (T0), immediately after endotracheal intubation (T1), at the time of muscle relaxant withdrawal (T2), 30 minutes after muscle relaxant withdrawal (T3), and 50 minutes after muscle relaxant withdrawal (T4). The current intensity and amplitude of the first motor evoked potential (MEP) were recorded. The waiting time from drug withdrawal to the first induced MEP was recorded. The amplitude and latency of somatosensory evoked potential (SEP) and MEP at T4 were recorded. Operation time, anesthesia time, intraoperative remifentanil dosage, the use of vasoactive drugs, recovery time, extubation time, and adverse reactions were recorded.
Results Compared with group P, HR and MAP were significantly increased at T1-T4 (P < 0.05), the amplitude of MEP induced for the first time were significantly increased (P < 0.05), the amplitudes of SEP and MEP at T4 were significantly increased and the latency period was significantly shortened (P < 0.05), the dosage of remifentanil was significantly decreased (P < 0.05), the number of bradycardia or hypotension were significantly decreased (P < 0.05), and the recovery time and extubation time were significantly shortened in group R (P < 0.05).
Conclusion Remimazolam can be safely used in spinal surgery requiring IONM, with small circulation fluctuation, quick recovery, less postoperative adverse reactions, little effect on SEP and MEP, which is conducive to improving the quality of IONM．
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