文章摘要
瑞马唑仑与丙泊酚对骨科手术患者围术期不良反应影响的比较：Meta分析
Camparison of effects of remimazolam and propofol on perioperative adverse reactions in orthopedic surgery patients: a meta-analysis
  
DOI：10.12089/jca.2026.01.012
中文关键词: 瑞马唑仑  丙泊酚  骨科手术  不良反应  Meta分析
英文关键词: Remimazolam  Propofol  Orthopedic surgery  Adverse reactions  Meta-analysis
基金项目:国家自然科学基金地区科学基金项目（82260973）
作者单位E-mail
陈天任 730000,兰州市,甘肃中医药大学第一临床医学院  
陈文强 730000,兰州市,甘肃中医药大学第一临床医学院  
唐璐 730000,兰州市,甘肃中医药大学第一临床医学院  
都忠莹 730000,兰州市,甘肃中医药大学第一临床医学院  
雷畅 730000,兰州市,甘肃中医药大学第一临床医学院  
杨沙沙 730000,兰州市,甘肃中医药大学第一临床医学院  
王春爱 甘肃省中医院麻醉科 chunaixx@163.com 
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中文摘要:
      
目的：采用Meta分析的方法比较瑞马唑仑与丙泊酚对骨科手术患者不良反应的影响。
方法：计算机检索Embase、Cochrane library、Web of Science、Pubmed、中国知网、维普、万方、中国生物医学文献数据库，收集关于瑞马唑仑与丙泊酚用于骨科患者手术的临床随机对照试验（RCT），检索时间为建库至2024年10月，采用Cochrane偏倚风险评估工具对纳入的文献进行质量评估，采用RevMan 5.4软件进行Meta分析。
结果：共纳入12篇RCTs，患者1 972例，其中瑞马唑仑组983例，丙泊酚组989例。Meta分析结果显示，与丙泊酚组比较，瑞马唑仑组低血压发生率明显降低（RR=0.39，95%CI 0.28～0.54，P<0.001）、心动过缓发生率明显降低（RR=0.29，95%CI 0.10～0.83，P=0.02）、呼吸抑制发生率明显降低（RR=0.21，95%CI 0.09～0.47，P=0.0002）、躁动发生率明显降低（RR=0.57，95%CI 0.41～0.77，P=0.0004）、术后谵妄发生率差异无统计学意义（RR=0.78，95%CI 0.48～1.26，P=0.31）、恶心呕吐发生率差异无统计学意义（RR=0.9，95%CI 0.66～1.24，P=0.53）。
结论： 瑞马唑仑与丙泊酚对骨科手术患者的术后谵妄和恶心呕吐的影响无显著差异，但前者对低血压、心动过缓、呼吸抑制及躁动的影响显著较低。
英文摘要:
      
Objective: To compare the effects of remimazolam versus propofol on adverse events in orthopedic surgery patients using meta-analysis.
Methods: A systematic search of Embase, Cochrane Library, Web of Science, PubMed, CNKI, VIP, Wanfang, and CBM databases was conducted from inception to October 2024 for randomized controlled trials (RCTs) evaluating remimazolam vs. propofol in orthopedic surgery. Cochrane risk-of-bias tool was used to assess study quality, and meta-analysis was performed using RevMan 5.4.
Results: Twelve RCTs were included, involving 1 972 patients, among whom 983 were in the remimazolam group and 989 were in the propofol group. Compared with the propofol group, the incidence of hypotension in the remimazolam group was significantly reduced (RR = 0.39, 95% CI 0.28 - 0.54, P < 0.001), the incidence of bradycardia was significantly lower (RR = 0.29, 95% CI 0.10-0.83, P = 0.02), the incidence of respiratory depression was significantly decreased (RR = 0.21, 95% CI 0.09 - 0.47, P = 0.0002), and the incidence of restlessness was significantly lower (RR = 0.57, 95% CI 0.41 - 0.77, P = 0.0004). There was no statistically significant difference in the incidence of postoperative delirium (RR = 0.78, 95% CI 0.48 - 1.26, P = 0.31) and in the incidence of nausea and vomiting (RR = 0.9, 95% CI 0.66 - 1.24, P = 0.53).
Conclusion: Remimazolam and propofol have similar effects on postoperative delirium and nausea/vomiting in orthopedic surgery, but remimazolam is associated with significantly reduced risks of hypotension, bradycardia, respiratory depression, and agitation.
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