文章摘要
瑞马唑仑复合瑞芬太尼用于支撑喉镜下声带手术的效果
Effect of remimazolam conbined with remifentanil in laryngoscope vocal cord surgery
  
DOI：10.12089/jca.2023.12.007
中文关键词: 瑞马唑仑  支撑喉镜  声带手术  全身麻醉
英文关键词: Remimazolam  Laryngoscope  Vocal cord surgery  General anesthesia
基金项目:
作者单位E-mail
汪威廉 434020,湖北省荆州市中心医院,长江大学附属荆州医院麻醉科  
龚洁 434020,湖北省荆州市中心医院,长江大学附属荆州医院疼痛科  
吴晓琴 434020,湖北省荆州市中心医院,长江大学附属荆州医院麻醉科  
张畅 434020,湖北省荆州市中心医院,长江大学附属荆州医院麻醉科  
肖锦亮 434020,湖北省荆州市中心医院,长江大学附属荆州医院麻醉科 290566696@qq.com 
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中文摘要:
      
目的 观察瑞马唑仑复合瑞芬太尼用于支撑喉镜下声带手术的临床效果。
方法 选择2022年1—8月在全麻下行支撑喉镜声带手术患者180例，男77例，女103例，年龄18～64岁，BMI 18～30 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为四组：丙泊酚组（C组）、瑞马唑仑1.0 mg·kg-1·h-1组（R1组）、瑞马唑仑1.5 mg·kg-1·h-1组（R2组）和瑞马唑仑2.0 mg·kg-1·h-1组（R3组），每组45例。C组麻醉维持采用静脉泵注丙泊酚5 mg·kg-1·h-1，R1组麻醉维持采用静脉泵注瑞马唑仑1.0 mg·kg-1·h-1，R2组麻醉维持采用静脉泵注瑞马唑仑1.5 mg·kg-1·h-1，R3组麻醉维持采用静脉泵注瑞马唑仑2.0 mg·kg-1·h-1，所有患者麻醉维持复合瑞芬太尼0.2 μg·kg-1·min-1。记录麻醉诱导前（T1）、支撑喉镜置入即刻（T2）、麻醉维持结束即刻（T3）、气管拔管时（T4）的HR、MAP和BIS。记录镇静起效时间、苏醒时间、拔管时的镇静-躁动评分、拔管后5 min的Ramsay评分。记录术中麻黄碱、硝酸甘油使用情况。记录注射痛、补救镇静例数，拔管后1 h内恶心呕吐、呼吸抑制等不良反应、术中知晓的发生情况。
结果 与C组比较，R1组T3时MAP、T2、T3时BIS明显升高，T4时MAP明显降低，镇静起效时间明显延长，麻黄碱使用率、注射痛发生率明显降低（P<0.05）；R2组T2、T4时HR明显减慢、MAP明显降低，T3时MAP明显升高，镇静起效时间、苏醒时间、拔管时间明显延长，麻黄碱使用率、注射痛发生率明显降低（P<0.05）；R3组T2、T4时HR明显减慢、MAP明显降低，镇静起效时间、苏醒时间、拔管时间明显延长，Ramsay评分明显升高（P<0.05）。与R1组比较，R2组T2、T4时HR明显减慢、MAP明显降低，T2、T3时BIS明显降低，苏醒时间、拔管时间明显延长（P<0.05）；R3组T2、T4时HR明显减慢，T2—T4时MAP、T2、T3时BIS明显降低，苏醒时间、拔管时间明显延长，Ramsay评分明显升高（P<0.05）。与R2组比较，R3组T3时MAP明显降低，Ramsay评分明显升高（P<0.05）。四组硝酸甘油使用率、补救镇静、恶心呕吐、呼吸抑制发生率差异均无统计学意义。
结论 瑞马唑仑可以安全用于支撑喉镜下声带手术的麻醉诱导和麻醉维持，与瑞马唑仑1.0、2.0 mg·kg-1·h-1比较，瑞马唑仑1.5 mg·kg-1·h-1复合瑞芬太尼麻醉维持能更好地维持术中患者血流动力学稳定。
英文摘要:
      
Objective To investigate the clinical effect of remimazolam combined with remifentanil in patients undergoing laryngoscope vocal cord surgery under general anesthesia.
Methods A total of 180 patients undergoing laryngoscope vocal cord surgery under general anesthesia from January to August 2022, 77 males and 103 females, aged 18-64 years, BMI 18-30 kg/m2, ASA physical status Ⅰ-Ⅲ were selected. The patients were divided into four groups using a random number table method: propofol group (group C), remimazolam 1.0 mg·kg-1·h-1 group (group R1), remimazolam 1.5 mg·kg-1·h-1 group (group R2), and remimazolam 2.0 mg·kg-1·h-1 group (group R3), 45 patients in each group. Group C maintained by intravenous infusion of propofol 5 mg·kg-1·h-1, groups R1, R2, and R3 were maintained by intravenous infusion of remimazolam 1.0, 1.5, and 2.0 mg·kg-1·h-1, respectively. All patients were combined with remifentanil 0.2 μg·kg-1·min-1. HR, MAP, and BIS were recorded before anesthesia induction (T1), immediately after laryngoscope insertion (T2), immediately at the end of anesthesia maintenance (T3), and at tracheal extubation (T4). The onset time of sedation, awakening time, sedation-agitation score at extubation and Ramsay score 5 minutes after extubation were recorded. The intraoperative use of ephedrine and nitroglycerin were recorded. The number of injection pain and remedy sedations were recorded, the occurrence of adverse reactions such as nausea and vomiting, respiratory depression within 1 hour after extubation, and intraoperative awareness were recorded.
Results Compared with group C, MAP at T3, BIS at T2 and T3 were significantly increased, MAP at T4 was significantly decreased, the onset time of sedation was significantly prolonged, the use of ephedrine and the incidence of injection pain were significantly decreased in group R1 (P < 0.05), HR and MAP were significantly decreased at T2 and T4, MAP was significantly increased at T3, the onset time of sedation, awakening time, extubation time were significantly prolonged, the use of ephedrine and the incidence of injection pain were significantly reduced in group R2 (P < 0.05), HR and MAP were significantly decreased at T2 and T4, the onset time of sedation, awakening time, extubation time were significantly prolonged, Ramsay score was significantly increased in group R3 (P < 0.05). Compared with group R1, HR and MAP were significantly decreased at T2 and T4, BIS was significantly decreased at T2 and T3, the awakening time and extubation time were significantly prolonged in group R2 (P < 0.05), HR at T2 and T4, MAP at T2-T4, BIS at T2 and T3 were significantly decreased, the awakening time and extubation time were significantly prolonged, Ramsay score was significantly increased in group R3 (P < 0.05). Compared with group R2, MAP at T3 was significantly decreased and Ramsay score was significantly increased in group R3 (P < 0.05). There were no significantly differences between the rates of nitroglycerin usage, rescue sedation, nausea and vomiting, and respiratory depression in the four groups.
Conclusion Remimazolam can be safely used for anesthesia induction and maintenance in laryngoscope vocal cord surgery. The maintenance of remimazolam 1.5 mg·kg-1·h-1 combined with remifentanil can better maintain the hemodynamics stability during the surgery than remimazolam 1.0 and 2.0 mg·kg-1·h-1.
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