瑞马唑仑复合瑞芬太尼喉罩静脉全身麻醉用于老年输尿管镜碎石取石术中的安全性及有效性观察

Safety and efficacy of remimazzolam combined with remifentanil laryngeal mask intravenous general anesthesia for ureteroscopic lithotripsy in elderly patients

目的探讨瑞马唑仑复合瑞芬太尼喉罩静脉全身麻醉用于老年输尿管镜碎石取石术中的安全性及有效性。方法选取2020年1—12月于湖南中医药高等专科学校附属第一医院进行输尿管镜碎石取石术的100例老年患者为研究对象,采用随机数字表法分为对照组与观察组,每组各50例。对照组采用丙泊酚复合瑞芬太尼麻醉,观察组采用瑞马唑仑复合瑞芬太尼麻醉。比较两组患者麻醉诱导前5min(T_(0))、置入喉罩时(T_(1))、置入喉罩5min后(T_(2))、拔除喉罩时(T_(3))的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)。比较分析两组患者的麻醉诱导时间、术中体动次数和麻醉苏醒时间,术后1d、3d、5d的简易精神状态量表(mini-mental state examination,MMSE)评分和视觉模拟评分法(visual analogue score,VAS)评分以及术后不良反应发生情况。结果与T0时刻比较,两组患者T_(1)、T_(2)、T_(3)时刻的MAP和HR均显著升高(P<0.05)。T_(1)、T_(3)时刻,观察组患者的MAP和HR均显著低于对照组(P<0.05)。观察组患者的麻醉诱导时间、术中体动次数及麻醉苏醒时间均显著少于对照组(P<0.05)。术后1d、3d和5d,观察组患者的MMSE评分均显著高于对照组(P<0.05),VAS评分均显著低于对照组(P<0.05)。两组患者术后不良反应总发生率比较差异无显著性(P>0.05)。结论瑞马唑仑复合瑞芬太尼喉罩静脉全身麻醉用于老年输尿管镜碎石取石术中,具有血流动力学水平稳定、麻醉效果佳等特点,且能显著改善患者术后认知功能和减轻患者术后疼痛。

Objective To investigate the safety and efficacy of remimazzolam combined with remifentanil laryngeal mask intravenous general anesthesia for ureteroscopic lithotripsy in elderly patients.Method 100 patients who underwent ureteroscopic lithotripsy in our hospital from January to December in 2020 were randomly divided into control group and observation group,50 cases in each group.The control group anesthetized with propofol combined with remifentanil,and the observation group anesthetized with remifentanil combined with remazolam.The mean arterial pressure(MAP)and heart rate(HR)were compared between two groups at 5 minutes before induction of general anesthesia(T_(0)),after laryngeal mask placement(T_(1)),5 minutes after laryngeal mask placement(T_(2)),and after laryngeal mask removal(T_(3)).Anesthesia induction time,intraoperative movement times and anesthesia recovery time,mini-mental state examination(MMSE)score and visual analogue score(VAS)1d,3d and 5d after surgery,the incidence of postoperative adverse reactions were compared and analyzed between two groups.Result Compared with T0,MAP and HR of two groups at T_(1),T_(2) and T_(3) were significantly increased(P<0.05).At T_(1) and T_(3),MAP and HR in observation group were significantly lower than those in control group(P<0.05).The anesthesia induction time,intraoperative body movement times and anesthesia recovery time in the observation group were significantly less than those in the control group(P<0.05).1d,3d and 5d after surgery,MMSE score of observation group was significantly higher than control group(P<0.05),VAS score was significantly lower than control group(P<0.05).There was no significant difference in the total incidence of postoperative adverse reactions between two groups(P>0.05).Conclusion Remazolam combined with remifentanil laryngeal mask intravenous general anesthesia used in ureteroscopic lithotripsy for elderly patients has the characteristics of stable hemodynamic indexes and good anesthesia effect,and can significantly improve postoperative cognitive function and relieve postoperative pain.