甲苯磺酸瑞马唑仑对老年高血压患者全麻诱导期间的血流动力学的影响

Effect of Remimazolam on Hemodynamics during General Anesthesia Induction in Elderly Hypertensive Patients

【目的】探讨甲苯磺酸瑞马唑仑用于老年高血压患者麻醉诱导的镇静效果及其对血流动力学的影响。【方法】选择2021年10月至2022年10月长沙市中心医院择期行全身麻醉且需气管插管的老年高血压患者100例,采用随机数字表法将其分为观察组(采用瑞马唑仑麻醉)和对照组(采用依托咪酯麻醉),每组50例。记录患者从诱导开始清醒状态到脑电双频指数(BIS)<60的时间,记录诱导前(T_(0))、诱导后到BIS<60(T_(1))、插管后1 min(T_(2))、插管后5 min(T_(3))4个时间点患者的平均动脉压(MAP)、心率(HR)及BIS值的变化,同时在这4个时间点采集血样本,比较两组患者血清去甲肾上腺素(NE)水平。比较两组麻醉诱导期间肌痉挛、心动过速、心动过缓、高血压、低血压等不良事件发生率。【结果】观察组T_(1)、T_(2)时的HR均高于T_(0)时,T_(0)、T_(2)时的MAP均高于T_(1),差异有统计学意义(P<0.05);对照组T_(0)、T_(2)时的MAP、HR均高于T_(1),差异有统计学意义(P<0.05);观察组T_(1)时的MAP、HR高于对照组,差异有统计学意义(P<0.05)。观察组、对照组T_(0)、T_(2)时的血清NE水平均高于T_(1)时,差异有统计学意义(P<0.05);观察组T_(2)、T_(3)时的血清NE水平低于对照组,差异有统计学意义(P<0.05)。观察组麻醉诱导起效时间较对照组长,而肌颤、低血压、心动过缓的发生率低于对照组,差异有统计学意义(P<0.05)。【结论】在老年高血压患者全麻诱导期使用瑞马唑仑可稳定患者血流动力学指标,诱导期的肌痉挛、低血压、心动过缓等不良反应的发生率较低。

【Objective】To explore the sedative effect and hemodynamic impact of remimazolam toluenesulfonate on anesthesia induction in elderly hypertensive patients.【Methods】A total of 100 elderly hypertensive patients who underwent elective general anesthesia and required tracheal intubation at the Changsha Central Hospital from October 2021 to October 2022 were randomly divided into an observation group(using remimazolam anesthesia)and a control group(using etomidate anesthesia)using a random number table method,with 50 patients in each group.The time from the onset of wakefulness to BIS values less than 60 was recorded,and the changes in mean arterial pressure(MAP),heart rate(HR),and BIS values were recorded at four time points:before induction(T_(0)),after induction to BIS<60(T_(1)),1 minute after intubation(T_(2)),and 5 minutes after intubation(T_(3)).Blood samples were collected at these four time points to compare the serum levels of norepinephrine(NE)between the two groups of patients.The incidence of adverse events such as muscle spasms,tachycardia,bradycardia,hypertension,and hypotension during anesthesia induction was compared between two groups.【Results】The HR at T_(1)and T_(2)in the observation group was higher than that at T_(0),and the MAP at T_(0)and T_(2)was higher than that at T_(1),with a statistically significant difference(P<0.05);The MAP and HR of the control group at T_(0)and T_(2)were higher than those of T_(1),with statistically significant differences(P<0.05);The MAP and HR of the observation group at T_(1)were higher than those of the control group,and the difference was statistically significant(P<0.05).The serum NE levels at T_(0)and T_(2)in the observation group and the control group were higher than those at T_(1),and the difference was statistically significant(P<0.05);The serum NE levels in the observation group at T_(2)and T_(3)were lower than those in the control group,with a statistically significant difference(P<0.05).The onset time of anesthesia induction in the observation group was longer than that in the ET group,and the incidence of muscle fibrillation,hypotension,and bradycardia was lower than that in the control group,with a statistically significant difference(P<0.05).【Conclusion】The use of remimazolam during the induction period of general anesthesia in elderly hypertensive patients can stabilize hemodynamic indicators,and the incidence of adverse reactions such as muscle spasms,hypotension,and bradycardia during the induction period is relatively low.