文章摘要
麻醉诱导前给予不同剂量瑞马唑仑对结核性脓胸患者胸腔镜纤维板剥脱手术后苏醒的影响
Effect of different doses of remimazolam administered before anesthesia induction on postoperative awakening in tuberculous empyema patients undergoing thoracoscopic fibrous peeling surgery
  
DOI：10.12089/jca.2026.03.005
中文关键词: 瑞马唑仑  麻醉诱导  结核  脑电双频指数  胸腔镜  纤维板剥脱术
英文关键词: Remimazolam  Anesthesia induction  Tuberculosis  Bispectral index  Thoracoscopic  Fibrous peeling surgery
基金项目:南京市卫生科技发展专项资金项目（YKK21125）
作者单位E-mail
张维峰 210003,南京市第二医院,南京中医药大学附属南京医院麻醉科  
王佳 210003,南京市第二医院,南京中医药大学附属南京医院麻醉科 janic@163.com 
李玥豪 210003,南京市第二医院,南京中医药大学附属南京医院麻醉科  
杨晓宇 210003,南京市第二医院,南京中医药大学附属南京医院麻醉科  
邓友明 210003,南京市第二医院,南京中医药大学附属南京医院麻醉科  
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中文摘要:
      
目的： 探讨在BIS监测下麻醉诱导前3 min给予不同剂量瑞马唑仑对结核性脓胸患者胸腔镜纤维板剥脱手术术后苏醒的影响。
方法： 选择行胸腔镜纤维板剥脱手术的结核性脓胸患者，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为四组：对照组（C组）、瑞马唑仑0.10 mg/kg组（R1组）、瑞马唑仑0.15 mg/kg组（R2组）和瑞马唑仑0.20 mg/kg组（R3组）。C组麻醉诱导前不给予任何药物，R1组、R2组和R3组分别于麻醉诱导前3 min静脉给予瑞马唑仑0.10、0.15和0.20 mg/kg。所有患者于麻醉开始后静脉给予环泊酚0.3～0.5 mg/kg，待BIS 60时，给予维库溴铵 0.1 mg/kg，同时给予舒芬太尼0.4 μg/kg，肌松完全起效后进行气管插管并行机械通气，麻醉过程中维持BIS 45～55。主要指标为苏醒时间。次要指标包括麻醉诱导前5 min、麻醉诱导后3 min、气管插管即刻、拔管即刻及拔管后10 min的HR、MAP和BIS，意识消失时间，拔管时间，手术时间和术中环泊酚用量。不良反应包括术后恶心、呕吐、窦性心动过缓和低血压。
结果： 共纳入患者80例，每组20例。与C组比较，R2组和R3组麻醉诱导后3 min HR明显增快、MAP明显升高，气管插管即刻HR明显减慢、MAP明显降低，意识消失时间、苏醒时间和拔管时间明显缩短，环泊酚用量明显减少（P<0.05）；R3组术后恶心、低血压发生率明显降低（P<0.05）。与R1组比较，R3组意识消失时间、苏醒时间和拔管时间明显缩短，环泊酚用量明显减少（P<0.05）。与R2组比较，R3组意识消失时间和苏醒时间明显缩短，环泊酚用量明显减少（P<0.05）。
结论： 在BIS监测下，行胸腔镜纤维板剥脱手术的结核性脓胸患者麻醉诱导前给予瑞马唑仑，可以减少环泊酚的用量、维持患者血流动力学稳定、降低麻醉相关并发症风险、加速术后康复，瑞马唑仑0.2 mg/kg剂量具有优势，值得临床推广。
英文摘要:
      
Objective: Explore the effects of different doses of remimazolam administered 3 minutes before induction of general anesthesia in tuberculous empyema patients undergoing thoracoscopic fibrous peeling surgery under BIS monitoring.
Methods: Patients aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅱ or Ⅲ, scheduled for horacoscopic fiberboard dissection surgery under general anesthesia were enrolled. Patients were randomly divided into four groups using a random number table method: the control group (group C), the remimazolam 0.10 mg/kg group (group R1), the remimazolam 0.15 mg/kg group (group R2) , and the remimazolam 0.20 mg/kg group (group R3). Group C was not given any medication before anesthesia induction. Patients in groups R1, R2, and R3 were intravenously administered remimazolam 0.10, 0.15, and 0.20 mg/kg 3 minutes before anesthesia induction respectively. After the start of anesthesia, all patients were given cyclopropofol 0.3-0.5 mg/kg. When BIS was 60, vecuronium 0.1 mg/kg and sufentanil 0.4 μg/kg were injected intravenously. After muscle relaxation was completed, the intubation was completed and mechanical ventilation was performed, and BIS was maintained at a level of 45-55 during anesthesia. The primary outcome was awakening time. Secondary outcomes included HR, MAP, and BIS 5 minutes before anesthesia induction, 3 minutes after anesthesia induction, immediate tracheal intubation tube, immediatetracheal extubation intubation, and 10 minutes after extubation, time of disappearance of consciousness, extubation time, surgical time, the dosage of ciprofol. Adverse reactions included nausea, vomiting, sinus bradycardia, and hypotension.
Results: Eighty patients were enrolled, 20 patients in each group. Compared with group C, the HR and MAP were significantly increased 3 minutes after anesthesia induction, while those were significantly decreased at the moment of tracheal intubation in groups R2 and R3, the disappearance time of consciousness, awakening time, and extubation time were significantly shortened, the dosage of ciprofol were significantly reduced in groups R2 and R3 (P < 0.05), the incidence of postoperative nausea, and hypotension in group R3 were significantly decreased (P < 0.05). Compared with group R2, the disappearance time of consciousness, awakening time, and extubation time were significantly shortened, the dosage of ciprofol were significantly decreased in group R3 (P < 0.05). Compared with group R3, the disappearance time of consciousness and awakening time were significantly shortened, the dosage of ciprofol were significantly decreased in group R3 (P < 0.05).
Conclusion: Under BIS monitoring, administering remimazolam to tuberculous empyeensure anesthesia safety,ma patients undergoing thoracoscopic fibrous peeling surgery before induction of general anesthesia can reduce the dosage of ciprofol, stabilize their hemodynamic indicators, reduce the occurrence of adverse reactions, promote postoperative recovery, remimazolam 0.2 mg/kg is more suitable, and is worthy of clinical promotion.
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