不同剂量瑞马唑仑在妇科腹腔镜手术中的全麻诱导效果

The induction effect of different doses of remidazolam on general anesthesia in gynecological laparoscopic surgery

目的:探讨不同剂量瑞马唑仑(Remimazolam)对成年女性喉罩置入时呼气末七氟烷最低肺泡有效浓度(MAC)的影响。方法:选取83例择期置入喉罩全麻下妇科腹腔镜手术患者作为研究对象,按照瑞马唑仑剂量不同将患者分为对照组(R0组,n=22)、低瑞马唑仑组(R1组,n=23)、中瑞马唑仑组(R2组,n=19)及高瑞马唑仑组(R3组,n=19)。所有患者均采用8%七氟烷和纯氧(6 L/min)同时吸入,行肺活量法吸入诱导,同时R1组、R2组及R3组持续静脉泵注瑞马唑仑分别为1、1.5及2.0 mg·kg^(-1)·h^(-1),R0组泵注等容量生理盐水。通过睫毛反射判断患者意识消失后,调整七氟烷呼气末浓度,设定为预设值。保持七氟烷浓度稳定至少15 min,置入喉罩并观察患者对喉罩置入即刻及30 s内的体动反应。采用Up and Down和序贯法测定各组喉罩置入时七氟烷的MAC值。结果:R0、R1、R2组及R3组患者喉罩置入时呼气末七氟烷MAC值分别为(2.94±0.18)%、(2.69±0.16)%、(2.32±0.16)%和(1.83±0.15)%,与R0组相比,R1-R3组MAC值均降低(P<0.05)。喉罩置入后,各组患者MAP和HR水平均高于置入前(P<0.05),但组间比较差异无统计学意义(P>0.05)。与R0组相比,瑞马唑仑泵注5 min、10 min及喉罩置入前、后1 min R1-R3组BIS值均增加,且随着瑞马唑仑剂量增加BIS值逐渐升高,差异有统计学意义(P<0.05)。与基础值相比,瑞马唑仑泵注5 min、10 min及喉罩置入前、后1 min,各组BIS值均降低,差异有统计学意义(P<0.05)。喉罩置入前、后1 min,各组内BIS值比较,差异无统计学意义(P>0.05)。结论:瑞马唑仑可降低成年女性喉罩置入时呼气末七氟烷MAC值,且瑞马唑仑1~2 mg·kg^(-1)·h^(-1)联合七氟烷诱导的安全性和有效性均较高。

Objective:To observe the effects of different doses of remimazolam on the minimum alveolar concentration(MAC)of sevoflurane at end-expiration during laryngeal mask insertion in adult female.Methods:83 female patients expected to undergo gynecological laparoscopic surgery under general anesthesia were selected as the research objects.They were divided into control group(R0 group,n=22),low remidazolam group(R1 group,n=23),medium remidazolam group(R2 group,n=19),and high remidazolam group(R3 group,n=19)according to different doses of remidazolam.All patients were induced by spirometry,using 8%sevoflurane and 100%oxygen(6 L/min).The R1,R2,and R3 groups were continuously administered remimazolam at doses of 1,1.5 and 2.0 mg·kg^(-1)·h^(-1),respectively,while the R0 group was injected with physiological saline of equal volume.The end-expiratory sevoflurane concentration was adjusted to a preset value after the eyelash reflex disappeared.After the end-expiratory concentration of sevoflurane was maintained stable for at least 15 min,a laryngeal mask was placed,and the patient s physical response to the placement of the laryngeal mask was observed immediately and within 30 s of placement.MAC of sevoflurane was measured using the Up and Down sequential method described by Dixon.Results:The calculated MAC of end-expiratory sevoflurane during laryngeal mask insertion was(2.94±0.18)%,(2.69±0.16)%,(2.32±0.16)%and(1.83±0.15)%in groups R0,R1,R2 and R3,respectively.Compared with the R0 group,the MAC values of the R1-R3 group decreased(P<0.05).After the placement of laryngeal mask,the levels of MAP and HR in each group of patients were higher than those before the placement(P<0.05),but there was no statistically significant difference between the groups(P>0.05).Compared with the R0 group,the BIS values of the R1-R3 group increased after 5 and 10 minutes of pump injection of ramazolam,as well as 1 minute before and 1 minute after laryngeal mask placement.The BIS values gradually increased with the increase of ramazolam dose,and the difference was statistically significant(P<0.05).Compared with the baseline values,the BIS values of each group decreased after 5 and 10 minutes of pump injection of ramazolam,and 1 minute before and after the placement of laryngeal mask(P<0.05).There was no statistically significant difference in BIS values between the groups before and 1 minute after the placement of the laryngeal mask(P>0.05).Conclusion:Remimazolam effectively reduce end-expiratory sevoflurane MAC values during laryngeal mask placement in adult female patients.The combination of remimazolam at a dose of 1~2 mg·kg^(-1)·h^(-1)with sevoflurane is a novel way for anesthesia induction that can be safely and effectively used in these patients.