文章摘要
瑞马唑仑对腹腔镜结直肠癌根治术患者细胞免疫功能和术后恢复质量的影响
Effect of remimazolam on cellular immune function and quality of postoperative recovery in patients undergoing laparoscopic radical surgery for colorectal cancer
  
DOI：10.12089/jca.2024.08.003
中文关键词: 瑞马唑仑  结直肠癌根治术  全身麻醉  免疫功能  恢复质量
英文关键词: Remimazolam  Radical surgery of colorectal neoplasms  General anesthesia  Immunity function  Quality of recovery
基金项目:甘肃省自然科学基金（23JRRA0988）
作者单位E-mail
刘艳 730030,兰州市,兰州大学第二医院麻醉科  
王迎斌 730030,兰州市,兰州大学第二医院麻醉科 wangyingbin6@163.com 
张丽 730030,兰州市,兰州大学第二医院麻醉科  
曹璐 730030,兰州市,兰州大学第二医院麻醉科  
张伟 730030,兰州市,兰州大学第二医院麻醉科  
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中文摘要:
      
目的：评价瑞马唑仑用于全身麻醉对腹腔镜结直肠癌根治术患者细胞免疫功能及术后恢复质量的影响。
方法：选择择期腹腔镜结直肠癌根治术患者60例，男36例，女24例，年龄18～80岁，BMI 18.5～28.0 kg/m2，ASA Ⅰ或Ⅱ级。按照随机数字将患者分为两组：瑞马唑仑组（R组）和丙泊酚组（P组），每组30例。麻醉诱导：R组静脉注射瑞马唑仑0.2～0.3 mg/kg，推注时间大于1 min，P组静脉注射丙泊酚1.0～2.0 mg/kg，待患者意识消失即MOAA/S评分为1～2分后，两组静脉注射舒芬太尼0.3～0.5 μg/kg和顺式阿曲库铵0.15～0.2 mg/kg完成气管插管。麻醉维持: R组静脉泵注瑞马唑仑1.0～2.0 mg·kg-1·h-1， P组静脉泵注丙泊酚4.0～12.0 mg·kg-1·h-1，两组协同静脉泵注瑞芬太尼0.1～0.2 μg·kg-1·min-1，间断静脉注射顺式阿曲库铵，术中维持BIS 40～60。记录麻醉诱导前、术毕即刻、术后24、72 h T细胞亚群CD3+、CD4+、CD8+和NK细胞，并计算CD4+/CD8+，记录麻醉诱导前、插管即刻、切皮即刻、术毕即刻、拔管即刻的HR、MAP、SpO2、BIS，术中心血管不良事件发生率和血管活性药物使用率。记录麻醉诱导前、术后24、72 h 15项恢复质量（QoR-15）量表评分，苏醒时Riker评分和Ramsay评分，苏醒时间、拔管时间、PACU停留时间、术后首次肛门排气时间、术后住院时间和术后24 h内恶心呕吐、嗜睡的发生率。
结果：与P组比较，R组术毕即刻、术后24 h NK、CD3+、CD4+细胞明显升高（P＜0.05），术毕即刻HR明显增快、MAP明显升高（P＜0.05），术中低血压、心动过缓发生率和血管活性药物使用率明显降低（P＜0.05），术后24、72 h QoR-15评分明显升高（P＜0.05）。两组苏醒时Riker评分和Ramsay评分差异无统计学意义。
结论：与丙泊酚比较，瑞马唑仑全身麻醉对腹腔镜结直肠癌根治术患者围术期免疫功能影响更小，术中低血压、心动过缓发生率更低，术后恢复质量更高。
英文摘要:
      
Objective: To evaluate the effect of remimazolam for general anesthesia on cellular immune function and quality of postoperative recovery in patients undergoing laparoscopic radical surgery for colorectal cancer.
Methods: Sixty patients undergoing laparoscopic radical surgery for colorectal cancer, 36 males and 24 females, aged 18-80 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were enrolled in this study. The patients were divided into remimazolam group (group R) and propofol group (group P) by using a random number, with 30 patients in each group. Induction of anesthesia was as follows: remimazolam at a dose of 0.2-0.3 mg/kg was intravenously infused (intravenous injection time > 1 minute) in group R, propofol at a dose of 1.0-2.0 mg/kg was intravenously infused in group P, and sufentanil at a dose of 0.3-0.5 μg/kg and cisatracurium at a dose of 0.15-0.2 mg/kg were intravenously infused injected after the patients consciousness disappeared, that is the modified observer's assessment of alertness/sedation score of 1-2 in two groups to complete tracheal intubation. Anesthesia maintenance was as follows: remimazolam at a dose of 1.0-2.0 mg·kg-1·h-1 was intravenously infused in group R, propofol at a dose of 4.0-12.0 mg·kg-1·h-1 was intravenously infused in group P, remifentanil at a dose of 0.1-0.2 μg·kg-1·min-1 was intravenously infused in two groups, and intravenous cisatracurium was injected intermittently to maintain the BIS value at 40-60 intraoperatively. The two groups percentage of CD3+, CD4+, CD8+T lymphocytes, natural killer cell and CD4+/CD8+ ratio were collected before induction of anesthesia, at immediately after the end of the surgery, and 24, 72 hours after surgery. The HR, MAP, percutaneous oxygen saturation, and bispectral index were collected before induction of anesthesia, immediately after endotracheal intubation, immediately after surgical incision, immediately after endotracheal extubation. The incidence of intraoperative adverse cardiovascular events and utilization rate of vasoactive drugs were collected. The quality of recovery-15 (QoR-15) scores before induction of anesthesia, and 24, 72 hours after surgery were recorded. The Riker and Ramsay scores at awakening, emergence time, tracheal extubation time, duration of post-anesthesia care unit (PACU) stay, first postoperative expiration time, and postoperative length of hospital stay were recorded. And the incidence of nausea, vomiting and sleepiness in the postoperative period of 24 hours were collected.
Results: Compared with group P,group R had significantly higher NK, CD3+, and CD4+ cells immediately after the end of the surgery and 24 hours after surgery (P < 0.05), significantly faster HR and higher MAP immediately after the end of the surgery (P < 0.05), significantly lower incidence of intraoperative hypotension, bradycardia and the utilization rate of vasoactive drugs (P < 0.05), and significantly higher QoR-15 scores 24, 72 hours after surgery (P < 0.05). There were no significant differences in the Riker and Ramsay scores between the two groups.
Conclusion: Compared with propofol, general anesthesia with remimazolam has less impact on the perioperative cellular immune function in patients undergoing laparoscopic radical surgery for colorectal cancer, with lower incidence of intraoperative hypotension and bradycardia, and higher quality of postoperative recovery.
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