文章摘要
长期饮酒对瑞马唑仑用于男性患者麻醉诱导半数有效浓度的影响
Effect of long-term alcohol consumption on median effective concentration of remimazolam for general anesthesia induction in male patients
  
DOI：10.12089/jca.2026.02.004
中文关键词: 瑞马唑仑  靶控输注  半数有效浓度  长期饮酒  浓度-效应关系
英文关键词: Remimazolam  Target-controlled infusion  Median effective concentration  Long-term alcohol consumption  Concentration-effect relationship
基金项目:山西省医师协会医师临床科研项目（YSXH-RF2022MZ009）
作者单位E-mail
王世民 046000,山西省长治市,长治医学院研究生院  
李姣 046000,山西省长治市,长治医学院研究生院  
王志棋 046000,山西省长治市,长治医学院研究生院  
王敏 046000,山西省长治市,长治医学院研究生院  
王翼 046000,山西省长治市,长治医学院研究生院  
李慧芬 长治医学院附属和济医院麻醉科 405498882@qq.com 
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中文摘要:
      
目的：探讨长期饮酒对瑞马唑仑用于男性患者麻醉诱导半数有效浓度（EC50）的影响。
方法：选择择期行全身麻醉下腹腔镜手术的男性患者，年龄35～64岁，ASA Ⅰ或Ⅱ级。采用动态匹配入组策略，根据饮酒情况分为两组：饮酒组和对照组。采用Dixon改良序贯法测定瑞马唑仑的EC50和95%有效浓度（EC95）。麻醉诱导时经外周静脉靶控输注（TCI）瑞马唑仑，观察输注瑞马唑仑后改良警觉/镇静（MOAA/S）评分及BIS。初始瑞马唑仑靶控输注浓度为0.4 μg/ml，瑞马唑仑诱导浓度梯度差值为0.05 μg/ml。根据上一例患者是否镇静有效而增加或减少一个浓度梯度。镇静无效标准为瑞马唑仑TCI稳态浓度达到后患者MOAA/S评分＞1分或BIS＞60。采用Probit回归分析法分别测定两组瑞马唑仑镇静的EC50和EC95及95%可信区间（95%CI）。主要指标为瑞马唑仑TCI稳态浓度达到后，使患者的MOAA/S评分≤1分的EC50。瑞马唑仑TCI麻醉诱导期间不良反应包括低血压、高血压、心动过缓、心动过速、低氧血症、呃逆。
结果：共纳入56例患者，饮酒组27例，对照组29例。饮酒组瑞马唑仑用于男性患者麻醉诱导镇静有效的EC50为0.442 μg/ml（95%CI 0.401～0.489 μg/ml），EC95为0.532 μg/ml（95%CI 0.486～0.817 μg/ml）。对照组瑞马唑仑用于男性患者麻醉诱导镇静有效的EC50为0.434 μg/ml（95%CI 0.394～0.479 μg/ml），EC95为0.526 μg/ml（95%CI 0.480～0.798 μg/ml）。两组瑞马唑仑麻醉诱导镇静有效的EC50、EC95及不良反应发生率比较差异无统计学意义。
结论：长期饮酒不会改变瑞马唑仑用于男性患者麻醉诱导的有效镇静浓度，其代谢特性和受体作用机制可使其成为此类人群的理想麻醉选择。
英文摘要:
      
Objective: To investigate the effect of long-term alcohol consumption on the median effective concentration (EC50) of remimazolam for general anesthesia induction in male patients.
Methods: Male patients aged 35-64 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective abdominal laparoscopic surgery under general anesthesia were selected. A dynamic matching enrollment strategy was adopted. They were divided into two groups based on alcohol consumption: the alcohol consumption group and the control group. Dixon's modified up-and-down sequential method was used to determine the EC50 and 95% effective concentration (EC95) of remimazolam. During anesthesia induction, sedation was achieved via target-controlled infusion (TCI) of remimazolam through a peripheral vein, and the modified observer's assessment of alertness/sedation (MOAA/S) scale and BIS were monitored after the TCI reached a steady state. The initial target concentration of remimazolam for TCI was set at 0.4 μg/ml, with a concentration gradient of 0.05 μg/ml between consecutive patients. The target concentration for each subsequent patient was increased or decreased by one gradient based on whether the previous patient achieved effective sedation. The criterion for ineffective sedation was defined as an MOAA/S score > 1 or a BIS value > 60 after the remimazolam TCI reached a steady state. Probit regression analysis was used to calculate the EC50, EC95, and their 95% confidence intervals (95%CI) of remimazolam-induced sedation in each group. The primary outcome was the EC50 of remimazolam that induced an MOAA/S score ≤ 1 after the TCI reached a steady state. Adverse reactions during remimazolam TCI for general anesthesia induction included hypotension, hypertension, bradycardia, tachycardia, hypoxemia, and hiccups.
Results: Fifty-six patients were finally enrolled, 27 patients in the alcohol consumption group and 29 patients in the control group. The EC50 of remimazolam for effective sedation during general anesthesia induction in male patients was 0.442 μg/ml (95% CI 0.401-0.489 μg/ml) in the alcohol consumption group and 0.434 μg/ml (95% CI 0.394-0.479 μg/ml) in the control group. The EC95 values were 0.532 μg/ml (95% CI 0.486-0.817 μg/ml) and 0.526 μg/ml (95% CI 0.480-0.798 μg/ml) for the alcohol consumption and control groups, respectively. There were no statistically significant differences in the EC50, EC95, or the incidence of adverse reactions between the two groups.
Conclusion: Long-term alcohol consumption does not alter the effective sedative concentration of remimazolam for general anesthesia induction in male patients. Given its metabolic characteristics and receptor mechanism, remimazolam can be an ideal anesthetic choice for this patient population.
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