瑞马唑仑对颅内血管瘤患者舒芬太尼麻醉诱导所致呛咳反应的影响

Effect of remimazolam on coughing reaction induced by sufentanil anesthesia induction in intracranial hemangioma patients

目的探寻麻醉诱导前给予小剂量的瑞马唑仑对颅内血管瘤患者舒芬太尼麻醉诱导所致呛咳反应的影响。方法选择北部战区总医院2020年1月至2022年12月择期全麻下行动脉瘤血管栓塞患者60例为研究对象,按照1∶1随机分为对照组(麻醉诱导前给予生理盐水2 ml)和试验组(麻醉诱导前给予0.02 mg/kg苯磺酸瑞马唑仑)。记录呛咳的发生情况及呛咳前后的心率(Heart rate,HR)和平均动脉压(Mean arterial pressure,MAP)及ΔHR和ΔMAP。ΔHR和ΔMAP为呛咳前后的HR和MAP的变化值。记录苏醒时间及术后恶心、呕吐、呼吸抑制、头晕、谵妄等不良反应的发生情况。结果试验组呛咳发生率低于对照组(6.7%vs.20%),差异具有统计学意义(P<0.05)。试验组呛咳前和呛咳后HR为(78.0±4.2)、(88.0±1.4)次/min,MAP为(80.5±2.1)、(87.5±6.4)mmHg;对照组呛咳前和呛咳后HR为(78.5±2.5)、(109.8±10.1)次/min,MAP为(81.7±3.2)、(108.2±9.0)mmHg。与呛咳前比较,对照组呛咳后HR和MAP显著增加(P<0.05),而试验组呛咳前后HR和MAP差异无统计学意义(P>0.05)。对照组ΔMAP和ΔHR分别为(31.3±10.1)mmHg和(24.5±11.9)次/min,试验组分别为(10.0±5.7)mmHg和(9.0±1.4)次/min,试验组HR和MAP变化幅度更小(P<0.05)。与对照组相比,试验组苏醒时间略延长,但差异无统计学意义(P>0.05)。试验组恶心、呕吐的发生率低于对照组(3.33%vs.26.7%),差异有统计学意义(P>0.05)。结论小剂量瑞马唑仑可有效抑制舒芬太尼麻醉诱导所致呛咳反应的发生,可避免剧烈循环波动造成不良预后。

Objective To investigate the effect of small dose of remimazolam before anesthesia induction on coughing reaction induced by sufentanil anesthesia induction in patients with intracranial hemangioma.Methods A total of 60 patients undergoing embolization for intracranial hemangioma under general anesthesia were selected from Northern Theater General Hospital and randomly divided into two groups according to 1∶1:control group(given 2 ml normal saline before anesthesia induction)and experimental group(given 0.02 mg/kg remimazolam before anesthesia induction).The occurrence of cough,HR and MAP before and after coughing,andΔHR andΔMAP were recorded.ΔHR andΔMAP were the changes of HR and MAP before and after coughing.The recovery time and the occurrence of postoperative adverse reactions,such as nausea,vomiting,respiratory depression,dizziness and delirium,were recorded.Results There were 2 cases(6.7%)of coughing in the experimental group and 6 cases(20%)in the control group.The incidence of coughing in the experimental group was significantly lower than that in the control group(P<0.05).The incidence of coughing in experimental group was significantly lower than that in control group(6.7%vs.20%,P<0.05).HR was(78.0±4.2)and(88.0±1.4)bpm and MAP was(80.5±2.1)and(87.5±6.4)mmHg before and after coughing in experimental group;HR was(78.5±2.5)and(109.8±10.1)bpm and MAP was(81.7±3.2)and(108.2±9.0)mmHg before and after coughing in control group.The HR and MAP increased significantly after coughing in control group compared with before coughing(P<0.05),while there was no significant difference in HR and MAP of experimental group before and after coughing(P>0.05).The difference in MAP and HR before and after coughing were(31.3±10.1)mmHg and(24.5±11.9)bpm in control group,and(10.0±5.7)mmHg and(9.0±1.4)bpm in experimental group,and the difference in HR and MAP of experimental group were less than that of control group(P<0.05).The recovery time of experimental group was slightly longer than that of control group,but there was no significant difference between the two groups(P>0.05).HR was(78.0±4.2)vs.(88.0±1.4)times/min and MAP was(80.5±2.1)vs.(87.5±6.4)mmHg before and after coughing in experimental group;HR(78.5±2.5)vs.(109.8±10.1)times/min and MAP was(81.7±3.2)vs.(108.2±9.0)mmHg in control group before and after coughing.MAP and HR increased after coughing in both groups compared with before coughing.The increase in HR and MAP before and after coughing was statistically significant in the control group(P<0.05).The incidence of nausea and vomiting in experimental group was lower than that in control group(3.33%vs.26.7%,P<0.05).Conclusion Low-dose remimazolam can effectively inhibit the coughing reaction induced by sufentanil anesthesia induction and avoid severe circulation fluctuation which may lead to poor prognosis.