甲苯磺酸瑞马唑仑联合艾司氯胺酮静脉麻醉在面部整形手术中的有效性及安全性对照研究

A Comparative Study on the Feasibility and Safety of Remimazolam Tosilate Combined with Esketamine in Intravenous Anesthesia for Facial Plastic Surgery

目的:探讨甲苯磺酸瑞马唑仑联合艾司氯胺酮在面部整形手术麻醉中的有效性及安全性。方法:按纳入和排除标准,最终选择2021年8月-2022年3月于武汉科技大学附属天佑医院行面部整形手术的60例就医者,采用随机数字表法分为实验组和对照组,各30例。对照组采用丙泊酚联合瑞芬太尼麻醉方案,实验组采用甲苯磺酸瑞马唑仑联合艾司氯胺酮麻醉方案。主要观察指标为:麻醉诱导前5 min(T_(1))、手术开始后5 min(T_(2))、术毕苏醒时(T_(3))的平均动脉压、心率、呼吸频率、脉搏血氧饱和度及T_(1)、T_(3)时间点的白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)血清水平。次要观察指标为:术中追加药物次数、定向力恢复时间、Steward苏醒评分及不良反应发生情况。结果:对照组平均动脉压、心率、呼吸频率、经皮动脉血氧饱和度变化较实验组明显(P<0.05);对照组T_(3)时间点血清IL-6、TNF-α水平变化较实验组明显(P<0.05);实验组苏醒质量均较对照组高(P<0.05);实验组手术期间心动过缓、血压下降、呼吸抑制及注射痛发生率较对照组低(P<0.05)。结论:在面部整形手术静脉麻醉中,采用甲苯磺酸瑞马唑仑联合艾司氯胺酮麻醉方案,对就医者术中的循环呼吸抑制轻微,术后应激反应和炎症反应弱,就医者苏醒快且发生不良反应少,是较为安全且有效的麻醉方案。

Objective To explore the effectiveness and safety of remimazolam tosilate combined with esketamine in anesthesia for facial plastic surgery.Methods According to the inclusion and exclusion criteria,60 patients who received facial plastic surgery in Tianyou Hospital Affiliated to Wuhan University of Science and Technology from August 2021 to March 2022 were finally included,which were randomly divided into experimental group and control group,with 30 cases in each group.The control group received propofol combined with remifentanil anesthesia induction.The experimental group received remimazolam combined with esketamine anesthesia induction.The main observation endpoints were the Mean arterial pressure,heart rate,respiratory rate,and pulse oxygen saturation which were monitored at 5 min before anesthesia induction(T_(1)),5min after the start of surgery(T_(2)),and when awakening after surgery(T_(3)),and serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)which were measured at T_(1)and T_(3).The minor observation endpoints were the number of additional drugs,directional force recovery time,Steward awakening score,and the occurrence of adverse reactions such as bradycardia,decreased blood pressure,respiratory depression,nausea and vomiting,dizziness,and injection pain.Results The changes of MAP,HR,RR and SpO_(2)in control group were more obvious than those in experimental group(P<0.05).The changes of serum levels of IL-6 and TNF-αin the control group at T_(3)were more obvious than those in the experimental group(P<0.05).The awakening quality of the experimental group was higher than that of the control group(P<0.05).The incidence of bradycardia,decreased blood pressure,respiratory depression and injection pain in the experimental group was significantly lower than that in the control group(P<0.05).Conclusion Rimazzolam tosilate combined with esketamine can be safely used for intravenous anesthesia in facial plastic surgery.Compared with propofol combined with remifentanil,it has the advantages of mild circulatory respiratory inhibition,weak stress response,mild postoperative inflammatory response,high awakening quality and few complications.