不同剂量甲苯磺酸瑞马唑仑对老年腹腔镜术后血流动力学参数及免疫功能的影响

Effect of different doses of remimazolam tosilate on hemodynamic parameters and immune function after laparoscopic surgery in elderly patients

目的分析不同剂量甲苯磺酸瑞马唑仑对老年腹腔镜术后血流动力学参数及免疫功能的影响。方法选择我医院收治的老年腹腔镜术后患者90例,所有患者均接受气管插管静吸复合麻醉,以甲苯磺酸瑞马唑仑剂量不同分为低剂量组(n=30,0.1 mg/kg)、中剂量组(n=30,0.15 mg/kg)与高剂量组(n=30,0.2 mg/kg)。对比3组麻醉诱导前(T0)、切片时(T1)、手术开始30 min(T2)、手术结束时(T3)平均动脉压(mean arterial pressure,MAP)和心率,对比3组术前、术后24 h精神状态检查(mini-mental state examination,MMSE)量表、丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、CD4^(+)、CD8^(+)水平,对比3组麻醉相关不良反应。结果3组的心率、MAP随时间的延长而增高,在组间、时点间、组间·时点间交互作用方面差异均有统计学意义(P<0.05)。术后24 h,3组MMSE评分均降低(P<0.05),且高剂量组MMSE评分高于低剂量组、中剂量组(P<0.05),中剂量组MMSE评分高于低剂量组(P<0.05)。术后24 h,3组MDA均升高(P<0.05),3组SOD均降低(P<0.05),且高剂量组MDA低于低剂量组、中剂量组(P<0.05),中剂量组MDA低于低剂量组(P<0.05),高剂量组SOD高于低剂量组、中剂量组(P<0.05),中剂量组SOD高于低剂量组(P<0.05)。术后24 h,3组CD4^(+)均升高(P<0.05),3组CD8^(+)均降低(P<0.05),且高剂量组CD4^(+)高于低剂量组、中剂量组(P<0.05),中剂量组CD4^(+)高于低剂量组(P<0.05),高剂量组CD8^(+)低于低剂量组、中剂量组(P<0.05),中剂量组CD8^(+)低于低剂量组(P<0.05)。3组麻醉相关不良反应总发生率比较差异无统计学意义(P>0.05)。结论0.2 mg/kg甲苯磺酸瑞马唑仑更有助于维持老年腹腔镜术后患者血流动力学,可改善患者免疫功能与认知功能,减轻氧化应激反应,且安全可靠。

Objective To analyze the effect of different doses of remimazolam tosilate on hemodynamic parameters and immune function in elderly patients after laparoscopic surgery.Methods Ninety elderly patients admitted to our hospital for laparoscopic surgery were selected.All patients received endotracheal intubation combined with inhalation anesthesia.According to different doses of remimazolam tosilate,they were divided into low-dose group(n=30,0.1 mg/kg),medium-dose group(n=30,0.15 mg/kg)and high-dose group(n=30,0.2 mg/kg).The mean arterial pressure(MAP)and heart rate before induction of anesthesia(T0),at the time of section(T1),at 30 min after operation(T2)and at the end of operation(T3)were compared among the three groups.The levels of mini-mental state examination(MMSE)scale score,malondialdehyde(MDA),superoxide dismutase(SOD),CD4^(+)and CD8^(+)before and at 24 h after operation were compared among the three groups,and the anaesthesia-related adverse reactions were compared among the three groups.Results The heart rate and MAP of the three groups were increased with the prolongation of time,and there were significant differences in interactions between groups,time points and time points between groups(P<0.05).At 24 h after operation,the MMSE score of the three groups was decreased(P<0.05),the MMSE score of the high-dose group was higher than that of the low-dose and medium-dose groups(P<0.05),and the MMSE score of the medium-dose group was higher than that of the low-dose group(P<0.05).At 24 h after operation,MDA in all three groups was increased(P<0.05),while SOD in all three groups was decreased(P<0.05).MDA was the lowest in the high-dose group,followed by medium-dose group and low-dose group(P<0.05),and SOD was the highest in the high-dose group,followed by medium-dose group and low-dose group(P<0.05).At 24 h after operation,CD4^(+)was increased in all three groups(P<0.05),while CD8^(+)was decreased in all three groups(P<0.05).CD4^(+)was the highest in the high-dose group,followed by medium-dose group and low-dose group(P<0.05),while CD8^(+)was the lowest in the high-dose group,followed by medium-dose group and low-dose group(P<0.05).There were no difference in the total incidence of anaesthesia-related adverse reactions among the three groups(P>0.05).Conclusion 0.2 mg/kg remimazolam tosilate is more effective in maintaining hemodynamics,improving immune function and cognitive function,and reducing oxidative stress in elderly patients after laparoscopic surgery,which is safe and reliable.