瑞马唑仑与依托咪酯应用于老年患者行经导管主动脉瓣置换术麻醉诱导的比较

Comparation of remimazolam and etomidate on anesthesia induction of transcatheter aortic valve replacement in elderly patients

目的:探讨苯磺酸瑞马唑仑与依托咪酯应用于主动脉瓣病变老年患者行经导管主动脉瓣置换术(TAVR)的麻醉诱导,观察镇静效果与对血流动力学的影响。方法:46例择期行TAVR的患者随机分为依托咪酯组(21例)及瑞马唑仑组(25例),麻醉诱导时分别静脉注射依托咪酯0.2mg/kg或瑞马唑仑0.3 mg/kg。监测并记录两组患者诱导开始至脑电波双频谱指数(bispectral index,BIS)<60所需要的时间;麻醉前(T0)、气管插管前(T1)及气管插管后即刻(T2)的BIS值、心率、平均动脉压(mean arterial pressure,MAP)、每搏输出量指数(stroke volume index,SVI)及心脏指数(cardiac index,CI);记录并对比两组麻醉诱导期间低血压、心动过缓、肌颤等不良反应的发生率以及补救给药、血管活性药物的使用情况;随访是否出现术中知晓、术后谵妄、术后肝、肾损伤等。结果:与依托咪酯组比较,瑞马唑仑组自麻醉诱导开始至BIS<60的时间更短[(64.8±16.4)vs.(100.2±46.8)s,P<0.01],补救给药次数更少(零vs.38.0%,P<0.01),镇静效果更好,且肌颤的发生率更低(零vs.19.0%,P<0.05)。瑞马唑仑组的麻醉诱导期间血流动力学指标与依托咪酯组,差异无统计学意义,两组均未发现术后认知功能障碍及肝损伤等,两组间肾损伤发生率,差异无统计学意义(9.5%vs.4.0%,P>0.05)。结论:瑞马唑仑麻醉诱导效果优于依托咪酯,且不良反应发生率低,可安全应用于TAVR的老年患者的麻醉诱导。

Objective:We aimed to investigate the sedation effect and hemodynamic index of remimazolam and etomidate in elderly patients with moderate and severe aortic valve disease during the anesthesia induction of transcatheter aortic valve replacement(TAVR).Methods:A total of 46 patients who received elective TAVR were randomly divided into etomidate group(n=21)and remimazolam group(n=25),with the injection doses of 0.2 mg/kg and 0.3 mg/kg,respectively.The time from sobriety to bispectral index(BIS)<60 was observed.BIS,heart rate(HR),mean arterial pressure(MAP),stroke volume index(SVI)and cardiac index(CI)were recorded before anesthesia induction(T0),before tracheal intubation(T1)and after tracheal intubation(T2).The incidence of adverse events such as hypotension,bradycardia,and muscle fasciculation during anesthesia induction was compared.And the remedial administration and use of vasoactive drugs,and whether there was intraoperative awareness,postoperative delirium,postoperative liver and kidney injury during postoperative follow-up were recorded.Results:The time from the beginning of induction to BIS<60 in remimazolam group was significantly shorter than that in etomidate group[(64.8±16.4)vs.(100.2±46.8)s,P<0.01],and the number of remedial times was less(zero vs.38.0%,P<0.01).The sedation effect was better,and the incidence of muscle fibrillation was lower(zero vs.19.0%,P<0.05)in remimazolam group.There was no significant difference in the hemodynamic indexes during induction between the two groups,and no postoperative adverse reactions like cognitive impairment and liver injury occurred in either the two groups.There was no difference in the incidence of renal injury between the two groups(9.5%vs.4.0%,P>0.05).Conclusions:The overall anesthesia induction effect of remimazolam is superior to etomidate,and it also has a lower incidence of adverse reactions.It can be safely used on anesthesia induction in elderly patients with moderate and severe aortic valve disease.