瑞马唑仑与丙泊酚全麻诱导对颈动脉内膜剥脱术老年患者脑氧饱和度及脑血流的影响

Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy

目的探讨瑞马唑仑与丙泊酚在颈动脉内膜剥脱术老年患者全身麻醉诱导过程中对脑氧饱和度和脑血流动力学的影响及安全性。方法选取43例颈动脉狭窄(狭窄程度70%及以上)患者(年龄60~75岁)随机分为瑞马唑仑组(R组)和丙泊酚组(P组),分别以瑞马唑仑(0.3 mg·kg^(-1))或丙泊酚(1.5~2 mg·kg^(-1))进行麻醉诱导,以入手术室(T0)、麻醉诱导后(T1)、意识消失时(T2)、意识消失后1 min(T3)、意识消失后2 min(T4)、气管插管前(T5)为时间节点,测量患者局部脑氧饱和度(SrO_(2))、大脑中动脉平均血流速度(Vm)、阻力指数(RI),并记录平均动脉压(MAP)、心率(HR)和心脏指数(CI)。结果两组患者麻醉诱导后SrO2均显著高于基线(P<0.05),意识消失后SrO_(2)均呈逐步下降趋势。两组间SrO_(2)相对变化平均值无明显差异。两组间除P组T5时MAP低于R组(P<0.05),其余Vm、RI、HR、CI各时间点差异无统计学意义(P>0.05)。各组T2~T5时Vm、HR、CI、MAP均较T0显著降低(P<0.05),但RI在组间或组内各时间点均无差异(P>0.05)。结论在老年患者颈动脉内膜剥脱术全麻诱导过程中,瑞马唑仑对脑氧饱和度的影响与丙泊酚无明显差异,但在血流动力学方面更具有优势。

Objective To investigate the effects and safety of remimazolam versus propofol on cerebral oxygen saturation and cerebral hemodynamics during the induction of general anesthesia in patients receiving carotid endarterectomy.Methods Forty-three patients(60-75 years old)with carotid artery stenosis(carotid artery stenosis greater than 70%)were randomly divided into the remimazolam group(R group)and the propofol group(P group).Anesthesia was induced with remimazolam(0.3 mg·kg^(-1))or propofol(1.5-2 mg·kg^(-1))individually.At time of admission(T0),post-anesthesia induction(T1),consciousness disappears(T2),1 minute after loss of consciousness(T3),2 minutes after loss of consciousness(T4)and pre-endotracheal intubation(T5),measurement in patients with regional cerebral oxygen saturation(SrO_(2)),mean velocity(Vm),resistance index(RI),mean arterial pressure(MAP),heart rate(HR)and cardiac index(CI)were recorded.Results SrO_(2) were increased significantly in both groups after induction of anesthesia compared with baseline(P<0.05)and decreased after loss of consciousness(P<0.05).There was no difference in the mean value of the relative changes in SrO_(2) between the groups.Meanwhile,the Vm,RI,HR and CI of each time point between two groups showed no statistically significant difference(P>0.05)while MAP in group P at T5 was lower than that in group R individually(P<0.05).In each group,Vm,HR,CI and MAP at T2-T5 were all significantly reduced compared with T0,with statistically differences(P<0.05).Specifically,there was no difference of RI at each time between or within groups(P>0.05).Conclusion Remimazolam can be administered safely and effectively during the induction of general anesthesia for carotid endarterectomy in elder population and it demonstrates superiority in hemodynamic changes compared with propofol.