依托咪酯和瑞马唑仑对全麻不停跳冠状动脉旁路移植术后心血管并发症的影响比较

Comparison of the effects of etomidate and remimazolam on cardiovascular complications after non-stop bypass surgery with general anesthesia

目的对比分析依托咪酯和瑞马唑仑两种麻醉诱导药物对于全麻不停跳冠状动脉旁路移植术术后患者心血管并发症的影响。方法采用前瞻性研究,选取2021年1月至2022年12月收治的拟行全麻不停跳冠状动脉旁路移植术患者80例,随机分为依托咪酯组和瑞马唑仑组,每组各40例。比较两组患者入手术室时(T0)、给药后脑电双频指数(bispectral index,BIS)≤60时(T1)、气管插管时(T2)、出手术室时(T3)的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR);比较两组患者给药起效时间、自然苏醒时间和术后心血管不良事件发生率。结果两组患者MAP和HR在T0、T1、T2、T3均无显著性差异(P>0.05)。瑞马唑仑组的药物起效时间略短于依托咪酯组,但无显著性差异(P=0.498),患者自然苏醒时间显著短于依托咪酯组(P=0.000)。两组患者术后均出现心血管不良反应,但两组患者心血管并发症发生率均无统计学差异(P>0.05)。结论依托咪酯与瑞马唑仑用于全麻不停跳冠状动脉旁路移植术均能获得较为稳定的血流动力学结果,对心血管不良反应发生率影响较小,而瑞马唑仑在患者自然苏醒时间上略优于依托咪酯。两种药物均可有效用于全麻不停跳冠状动脉旁路移植术患者麻醉诱导镇静。

Objective To compare and analyze the effects of two anesthetic-inducing drugs,etomidate and remimazolam,on cardiovascular complications in patients after general anesthesia non-stop bypass surgery.Methods A prospective study was used.Eighty patients admitted between January 2021 and December 2022 for proposed general anesthesia non-stop bypass surgery were selected and randomly divided into etomidate and remimazolam groups for surgery,with 40 patients in each group.The mean arterial pressure(MAP)and heart rate(HR)of the two groups were compared at the time of admission to the operating room(T0),the bispectral index(BIS)≤60(T1),tracheal intubation(T2),and leaving the operating room(T3).To compare the onset time of drug administration and natural awakening time,and the incidence of postoperative cardiovascular adverse events between the two groups.Results There was no significant difference in MAP and HR at T0,T1,T2 and T3 between the two groups(P>0.05).The drug onset time in the remimazolam group was slightly shorter than that in the etomidate group,but there was no significant differ-ence(P=0.498),and the natural awakening time of patients was significantly longer in the etomidate group(P=0.000).Postoperative cardiovascular adverse reactions were observed in both groups,but there was no statistically significant difference in the incidence of cardiovascular complications between the two groups(P>0.05).Conclusion Both etomidate and remimazolam can achieve relatively stable hemodynamic results in general anesthesia for non-stop coronary artery bypass grafting,with little impact on the incidence of cardio-vascular adverse reactions.However,remimazolam is slightly better than etomidate in terms of patients'natural awakening time.Both drugs can be effectively used for anesthesia induced sedation in patients undergoing non-stop coronary artery bypass grafting under general anesthesia.