瑞马唑仑用于全身麻醉对终末期肾病患者术后恢复质量及血清肌酐水平的影响

Effect of remimazolam-based total intravenous anesthesia on postoperative quality of recovery and serum creatinine in patients with end-stage renal disease

目的探讨瑞马唑仑用于全身麻醉对终末期肾病患者术后恢复质量和血清肌酐水平的影响。方法选取择期全麻下行腹腔镜腹膜透析管置入术患者252例,年龄18~76岁,体重指数(BMI)17.4~26.0 kg/m^(2)。采用随机数字表法分为两组:瑞马唑仑全凭静脉麻醉组(R组)和丙泊酚全凭静脉麻醉组(P组),每组126例。采用15项恢复质量量表(QoR-15)评估患者术前(D0)、术后第1天(D1)、术后第3天(D3)的恢复质量;于D0、D1两时点抽血比较两组患者手术前后血清肌酐水平变化;记录患者意识恢复时间、拔管时间、恢复室停留时间;记录两组注射痛、低血压、心动过缓、恶心呕吐、苏醒期谵妄的发生率。组间比较采用t检验或χ^(2)检验,组内比较采用重复测量方差分析。结果两组内患者QoR-15评分变化趋势相同:D0时点最高,D1时点最低,D3时点较D1有所升高,但仍低于D0时点。R组患者各时点QoR-15评分差异有统计学意义[(124.2±8.4)、(103.2±10.4)、(114.7±10.5)分,F=143.747,P<0.01]。P组患者各时点QoR-15评分差异有统计学意义[(124.5±10.0)、(102.5±11.9)、(114.6±12.8)分,F=118.373,P<0.01]。两组内3时点QoR-15评分多重比较差异均有统计学意义(P<0.01)。两组间各时点QoR-15评分比较差异无统计学意义(t=-0.330、0.509、0.049,P>0.05)。两组患者手术前后血清肌酐水平变化差异无统计学意义[(59.09±13.5)μmol/L比(70.38±12.9)μmol/L,t=-0.605,P>0.05]。R组低血压发生率指标低于P组(13.6%比57.6%,χ^(2)=52.778,P<0.01)、R组心动过缓发生率指标低于P组(13.6%比57.6%,χ^(2)=52.778,P<0.01)、R组注射痛发生率指标低于P组(0.8%比80.0%,χ^(2)=162.818,P<0.01)。两组意识恢复时间、拔管时间、恢复室停留时间(t=0.353、-0.669、-0.543,P>0.05)及恶心呕吐发生率、苏醒期谵妄发生率(χ^(2)=0.020、0.161,P>0.05)差异均无统计学意义。结论瑞马唑仑用于ESRD患者的全身麻醉,不影响患者术后恢复质量和血清肌酐水平,对循环影响小,术中不良反应发生率低,具有一定的临床价值。

Objective To investigate the effect of remimazolam-based total intravenous anesthesia on postoperative quality of recovery and serum creatinine in patients with end-stage renal disease.Methods A total of 252 patients with end-stage renal disease,age 18-76 years,body mass index(BMI)17.4-26.0 kg/m^(2),scheduled for Laparoscopic peritoneal dialysis catheter implantation,were divided into two groups using a random table method:the remimazolam-based total intravenous anesthesia group(group R)and the propofol based total intravenous anesthesia(group P),with 126 cases in each group.The quality of postoperative recovery-15(QoR-15)scores at the day before surgery(D0),postoperative day 1(D1)and postoperative day 3(D3)were recorded.The changes of serum creatinine of D0 and D1 were compared between the two groups.Time to recovery of consciousness、time to extubation、duration of post-anesthesia care unit stay were recorded in the two groups.The incidence of intraoperative hypotension、bradycardia、injection pain、postoperative nausea and vomiting(PONV)and emergence delirium at the post-anesthesia care unit(PACU)were observed.T-test or Chi-square test were used for comparison between the two groups.Repeated Measures Analysis of Variance(RMANOVA)was used for comparison of the two groups.Results The QoR-15 scores on D1 were significantly lower compared with D0 and D3,the scores on D3 were significantly lower compared with D0.The QoR-15 scores at three time points were significantly different in both group R[(124.2±8.4),(103.2±10.4),(114.7±10.5),F=143.747,P<0.01]and group P[(124.5±10.0),(102.5±11.9),(114.6±12.8),F=118.373,P<0.01],multiple comparisons of the two groups also had significant differences(P<0.01).The changes of QoR-15 scores over time had no significant difference between the groups(t=-0.330,0.509,0.049,P>0.05).There were no significant difference in the changes of serum creatinine between the two groups[(59.09±13.5)μmol/L vs.(70.38±12.9)μmol/L,t=-0.605,P>0.05]The incidence of intraoperative hypotension in group R were lower than that in group P(13.6%vs.57.6%,χ^(2)=52.778,P<0.01).The incidence of intraoperative bradycardia in group R were lower than that in group P(13.6%vs.57.6%,χ^(2)=52.778,P<0.01).The incidence of injection pain in group R were lower than that in group P(0.8%vs.80.0%,χ^(2)=162.818,P<0.01).There were no significant difference in time to recovery of consciousness,time to extubation,duration of PACU stay(t=0.353,-0.669,-0.543,P>0.05)and the incidence of PONV and emergence delirium at the PACU(χ^(2)=0.020,0.161,P>0.05)between two groups.Conclusion Remimazolam-based total intravenous anesthesia provided a similar QoR and serum creatinine to propofol in patients with end-stage renal disease,and has less impact on circulation,lower incidence of adverse reactions during operation,and has centain clinical value.