目的 比较瑞马唑仑与丙泊酚用于肺癌电视胸腔镜手术患者的麻醉效果及安全性.方法 回顾性分析进行电视胸腔镜手术治疗的肺癌患者的临床资料,其中瑞马唑仑组给予瑞马唑仑麻醉,丙泊酚组给予丙泊酚麻醉.比较2组患者麻醉诱导前(T0)、气管插管5 min后(T1)、手术1 h(T2)、关胸时(T3)、拔管后5 min(T4)的平均动脉压(MAP)、心率(HR)变化情况,记录2组患者镇静起效时间、苏醒时间及拔管时间,比较T0与T4时应激反应情况[促肾上腺皮质激素(ACTH)、皮质醇(Cor)],在T4用Ramsay镇静评分(RSS)评估镇静程度,术后2、12和24 h用视觉模拟评分(VAS)评估疼痛程度,观察围术期麻醉相关不良事件发生情况.结果 瑞马唑仑组58例,丙泊酚组64例.瑞马唑仑组和丙泊酚组 T1 时 MAP 分别为(85.03±4.37)和(78.24±4.48)mmHg,T2时 MAP 分别为(80.39±3.95)和(75.49±4.11)mmHg,T3 时 MAP 分别为(84.43±4.02)和(79.59±3.97)mmHg,T2 时 HR 分别为(76.44±5.75)和(72.39±6.03)beat·min-1,在统计学上差异均有统计学意义(均P＜0.05).瑞马唑仑组和丙泊酚组镇静起效时间分别为(62.45±6.27)和(72.33±7.19)s,苏醒时间分别为(7.22±1.23)和(8.24±1.48)min,拔管时间分别为(8.34±1.50)和(10.09±1.83)min,T4 时 RSS 评分分别为(2.03±0.39)和(1.88±0.35)分,在统计学上差异均有统计学意义(均P＜0.05).瑞马唑仑组和丙泊酚组麻醉相关不良事件总发生率分别为6.90％和21.88％,在统计学上差异有统计学意义(P＜0.05).结论 瑞马唑仑与丙泊酚在肺癌电视胸腔镜手术麻醉中均能发挥良好镇静效果,瑞马唑仑麻醉术中血流动力学更平稳,且起效及消除更快,安全性更高.
Objective To compare the anesthetic effect and safety of remimazolam and propofol on patients underwent video-assisted thoracoscopic surgery for lung cancer.Methods Clinical data of patients with lung cancer underwent video-assisted thoracoscopic surgery were retrospectively collected.Remimazolam group was anesthetized by remimazolam,and propofol group was anesthetized by propofol.The changes in mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups of patients before anesthesia induction(T0),after 5 min of tracheal intubation(T1),after 1 h of surgery(T2),during thorax closure(T3)and at 5 min after extubation(T4).The sedation onset time,recovery time and extubation time in the two groups were recorded.Stress response indicators[adrenocorticotropic hormone(ACTH),cortisol(Cor)]were compared at T0 and T4.Ramsay sedation score(RSS)was used to assess the sedation degree at T4.Visual analogue score(VAS)was applied to evaluate the pain degree at 2,12 and 24 h after surgery,and the perioperative anaesthesia-related adverse events were observed.Results There were 58 cases in remimazolam group and 64 cases in propofol group.The MAP values at T1 in remimazolam group and propofol group were(85.03±4.37)and(78.24±4.48)mmHg;at T2 were(80.39±3.95)and(75.49±4.11)mmHg;at T3 were(84.43±4.02)and(79.59±3.97)mmHg;the HR values at T2 were(76.44±5.75)and(72.39±6.03)beat·min-1,the difference were all significant(all P＜0.05).The sedation onset times in remimazolam group and propofol group were(62.45±6.27)and(72.33±7.19)s;the recovery times were(7.22±1.23)and(8.24±1.48)min;the extubation times were(8.34±1.50)and(10.09±1.83)min;the RSS scores at T4 were(2.03±0.39)and(1.88±0.35)points,the difference were all significant(all P＜0.05).The total incidence rates of anesthesia-related adverse events in remimazolam group and propofol group were 6.90％and 21.88％,respectively(P＜0.05).Conclusion Both remimazolam and propofol can play a good sedative effect during lung cancer video-assisted thoracoscopic surgery anesthesia.Remimazolam anesthesia has more stable intraoperative hemodynamics,faster onset and elimination,and higher safety.
姚晶曼;胡友洋;张欢欢;孔婧;孟璐;李若男;董喆
安徽省胸科医院麻醉科,安徽合肥 230032
药学
瑞马唑仑;丙泊酚;电视胸腔镜;肺癌;镇静
remimazolam;propofol;video-assisted thoracoscopy;lung cancer;sedation
《中国临床药理学杂志》 2024 (008)
1111-1115 / 5
10.13699/j.cnki.1001-6821.2024.08.005
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