瑞马唑仑对妇科腹腔镜手术患者术后恶心呕吐的影响

Effects of remimazolam on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic operation

目的探讨瑞马唑仑对妇科腹腔镜手术(laparoscopic operation,LO)患者术后恶心呕吐(postoperative nausea and vomiting,PONV)的影响。方法将择期行妇科LO的患者随机分为对照组和试验组,每组40例,两组均采用全麻。对照组静脉注射丙泊酚、舒芬太尼、顺阿曲库铵行全麻诱导,丙泊酚、瑞芬太尼靶控输注(target-controlled infusion,TCI),行麻醉维持;试验组静脉注射瑞马唑仑、舒芬太尼、顺阿曲库铵,行全麻诱导,瑞马唑仑、瑞芬太尼TCI,行麻醉维持。记录术后0~8 h内、术后8~24 h内PONV发生情况;记录麻醉诱导前(T0)、麻醉诱导后(T1)、手术结束时(T2)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)及血氧饱和度;记录术后24 h内头疼、眩晕和嗜睡发生情况。结果术后0~8 h,试验组PONV发生率低于对照组(10.0%vs 32.5%,P<0.05)。对照组T1较T0时MAP明显下降,HR明显减慢(P<0.05)。T1对照组MAP较试验组明显下降,HR明显减慢(P<0.05)。对照组术后头痛发生率高于试验组,差异有统计学意义(27.5%vs 5.0%,P<0.05)。结论瑞马唑仑较丙泊酚用于妇科LO患者的全麻镇静,术后0~8 h内PONV发生率更低,术中血流动力学更平稳,且不良反应的发生率更低。

Objective To investigate the effects of remimazolam on postoperative nausea and vomiting(PONV)in patients undergoing gynecological laparoscopic operation(LO).Methods The patients undergoing gynecological LO were randomly divided into control group and experimental group,40 cases in each group,both groups were given intravenous anesthesia.The control group received intravenous injection of propofol,sufentanil and cisatracurium for general anesthesia induction,and target-controlled infusion(TCI)of propofol and remifentanil for anesthesia maintenance.The experimental group received intravenous injection of remimazolam,sufentanil and cisatracurium for general anesthesia induction,and TCI of remimazolam and remifentanil for anesthesia maintenance.The occurrence of PONV within 0-8 h and 8-24 h after surgery were recorded.Mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation were recorded before anesthesia induction(T0),after anesthesia induction(T1)and end of surgery(T2).The incidence of headache,dizziness and drowsiness within 24h after surgery were recorded.Results The incidence of PONV in experimental group was lower than that in control group 0-8 h after operation(10.0%vs 32.5%,P<0.05).In control group,MAP and HR decreased significantly at T1 compared with T0(P<0.05).The MAP and HR in control group were significantly lower than those in experimental group at T1(P<0.05).The incidence of postoperative headache in control group was significantly higher than that in experimental group(27.5%vs 5.0%,P<0.05).Conclusion Remimazolam has a lower incidence of PONV within 0-8 h after surgery,more stable intraoperative hemodynamics,and fewer adverse reactions than propofol for general anesthesia in patients with gynecological LO.