目的 分析老年患者腰-硬联合麻醉术中给予不同剂量瑞马唑仑的有效性及安全性.方法 纳入2020年5月—2023年4月在武穴市第一人民医院手术需进行腰-硬联合麻醉的老年患者126例,随机分为低剂量组[42例,术中持续泵注2 μg/(kg·min)瑞马唑仑]、中剂量组[42例,术中持续泵注3 μg/(kg·min)瑞马唑仑]、高剂量组[42例,术中持续泵注4 μg/(kg·min)瑞马唑仑],评估患者麻醉前(T0)、麻醉给药5 min(T1)、15 min(T2)、30 min(T3)时镇静程度并记录生命体征指标,记录患者麻醉起效时间、阻滞完善时间,统计麻醉给药后恶心呕吐、低血压等不良反应发生情况.结果 三组患者T1、T2、T3时Ramsay评分较T0时均升高(P＜0.05),中剂量组、高剂量组T2、T3时Ramsay评分高于低剂量组(P＜0.05),高剂量组T2、T3时Ramsay评分高于中剂量组(P＜0.05),低剂量、中剂量组T2、T3时平均动脉压、心率高于高剂量组(P＜0.05);高剂量组、中剂量组麻醉起效时间、阻滞完善时间均短于低剂量组(P＜0.05);低剂量组、中剂量组低氧血症、低血压等不良反应总发生率低于高剂量组(P＜α,α=0.017).结论 老年患者腰-硬联合麻醉术中给予3 μg/(kg·min)的瑞马唑仑效果较为理想,其镇痛作用优于2 μg/(kg·min),对生命体征的影响低于4 μg/(kg·min),不良反应较少,兼顾镇静作用与麻醉安全性.
Objective To analyze the effectiveness and safety of different doses of remimazolam in elderly patients with combined spinal-epidural anesthesia.Methods From May 2020 to April 2023,126 elderly patients who needed combined spinal-epidural anesthesia in Wuxue First People's Hospital were included and randomly divided into low-dose group[42 cases,continuous infusion of 2 μg/(kg·min)reimazolam during operation],medium-dose group[42 cases,continuous infusion of 3 μg/(kg·min)reimazolam during operation],and high-dose group[42 cases,continuous infusion of 4 μg/(kg·min)reimazolam during operation].The degree of sedation and vital signs were recorded at 5 minutes(T1),15 minutes(T2),and 30 minutes(T3)of administration,and the anesthesia effective time and block completion time were recorded,and the incidence of adverse reactions such as nausea,vomiting,and hypotension after anesthesia administration were recorded.Results The Ramsay scores at T1,T2 and T3 of the three groups were significantly higher than those at T0(P＜0.05).The Ramsay scores of the middle-dose group and high-dose group were significantly higher than those of the low-dose group at T2 and T3(P＜0.05).The Ramsay scores of the high-dose group were significantly higher than those of the middle-dose group at T2 and T3(P＜0.05).The mean arterial pressure and heart rate of the low-dose group and the middle-dose group at T2 and T3 were higher than those of the high-dose group(P＜0.05).The effective time of anesthesia and block completion time in the high-dose group and the middle-dose group were significantly shorter than those in the low-dose group(P＜0.05).The total incidences of adverse reactions such as hypoxemia and hypotension in the low-dose group and the middle-dose group were significantly lower than those in the high-dose group(P＜α,α=0.017).Conclusions The effect of 3 μg/(kg·min)remimazolam in elderly patients with spinal-epidural combined anesthesia is ideal,its analgesic effect is better than 2 μg/(kg·min),the impact on vital signs is less than 4 μg/(kg·min),with fewer adverse reactions,which is a balance between the sedative effect and the safety of anesthesia.
何胜强;雷志强;梁晓山
武穴市第一人民医院麻醉科(湖北武穴 435400)
腰-硬联合麻醉;瑞马唑仑;剂量;随机对照
combined spinal-epidural anesthesia;remimazolam;dose;randomized control
《广州医药》 2024 (004)
411-415 / 5
10.3969/j.issn.1000-8535.2024.04.014
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