年龄因素对瑞马唑仑全麻诱导期患者情绪的影响

Effect of age on mood of patients during induction of general anesthesia with remimazolam

目的评价年龄因素对瑞马唑仑全麻诱导期患者情绪的影响。方法择期行气管插管全身麻醉手术患者80例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄5~80岁,BMI 18~30 kg/m^(2),根据年龄分为4组(n=20):未成年组(R_(1)组,5~17岁)、青年组(R_(2)组,18~44岁)、中年组(R_(3)组,45~59岁)及老年组(R_(4)组,60~80岁)。各组全麻诱导均静脉注射瑞马唑仑负荷剂量0.1 mg/kg,继以0.1 mg·kg^(-1)·h^(-1)维持,其余全麻诱导及维持用药均相同。记录瑞马唑仑静脉注射后3 min内患者情绪变化,并于给药后1、2、3 min时记录脑电波、改良警觉镇静评分(MOAA/S评分),记录诱导期不良反应发生情况。结果与R_(1)组比较,R_(3)及R_(4)组愉快情绪发生率显著降低,情绪分级降低,梦境Likert评分、MOAA/S评分降低,R_(2)组梦境Likert评分、MOAA/S评分降低,R_(4)组全麻诱导期低氧血症发生率升高(P<0.01);与R_(2)组比较,R_(3)及R_(4)组愉快情绪发生率降低,R_(4)组MOAA/S评分降低(P<0.05)。与R_(1)组和R_(2)组比较,R_(3)及R_(4)组β波百分比降低,θ与δ波百分比升高(P<0.01)。与R_(3)组比较,R_(4)组β波百分比降低,δ波百分比升高(P<0.01)。结论全麻诱导期瑞马唑仑0.1 mg/kg可引起愉快情绪发生,同时伴随脑电β波信号活动增强,以45岁以下患者更为明显。

Objective To evaluate the effect of age on mood of patients during induction of general anesthesia with remimazolam.Methods Eighty American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,undergoing elective surgery with general anesthesia requiring tracheal intubation,aged 5-80 yr,with body mass index 18-30 kg/m^(2),were divided into 4 groups(n=20 each)according to different ages:juvenile group(R_(1) group,5-17 yr),youth group(R_(2) group,18-44 yr),middle-aged group(R_(3) group,45-59 yr)and elderly group(R_(4) group,60-80 yr).Remimazolam was intravenously injected in a loading dose of 0.1 mg/kg for induction of general anesthesia,followed by an infusion of 0.1 mg·kg^(-1)·h^(-1) for maintenance of general anesthesia,and the other anesthetics for induction and maintenance of anesthesia were all the same in each group.The changes in emotion and brain wave within 3 min after remimazolam injection were recorded.The brain waves and Modified Observer′s Assessment of Alertness and Sedation(MOAA/S)scale score were recorded at 1,2 and 3 min after administration.Adverse effects during anesthesia induction were also recorded.Results Compared with group R1,the incidence of happy mood was significantly decreased,the grade of mood was decreased,and the dream Likert score and MOAA/S score were decreased in R_(3) and R_(4) groups,and the dream Likert score and MOAA/S score were decreased in group R_(2),and the incidence of hypoxemia during induction of general anesthesia was increased in group R_(4)(P<0.01).Compared with group R_(2),the incidence of happy mood was significantly decreased in R3 and R_(4) groups,and MOAA/S score was significantly decreased in group R_(4)(P<0.05).Compared with R_(1) and R_(2) groups,the proportion of beta bands was significantly decreased,and the proportion of theta and delta bands was increased in R_(3) and R_(4) groups(P<0.01).Compared with group R_(3),the proportion of beta band was significantly decreased,and the proportion of delta band was increased in group R_(4)(P<0.01).Conclusion Remimazolam 0.1 mg/kg used for induction of general anesthesia can cause happy mood,accompanied by enhanced brain electrical signal activity of beta band,especially in the patients under 45 yr of age.