不同剂量瑞马唑仑全麻诱导在非小细胞肺癌根治性切除术中的应用研究

Application of general anesthesia induction with remimazolam at different doses in radical resection of non-small cell lung cancer

目的 比较不同剂量瑞马唑仑全麻诱导在非小细胞肺癌(NSCLC)根治性切除术中的应用效果。方法 选择2021年1月—2023年6月本院收治的行NSCLC根治性切除术的患者144例作为研究对象,以计算机随机数字生成器分为A组、B组和C组共三组,每组各48例,分别以0.2 mg/kg、0.3 mg/kg、0.4 mg/kg瑞马唑仑行麻醉诱导。比较三组术中麻醉药物用量、围术期指标、镇静效果、恢复时间、围术期血流动力学指标(T_1:诱导开始时,T_2:气管插管即刻,T_3:气管插管后10 min, T_4:手术结束时)及不良反应。结果 三组术中舒芬太尼、罗库溴铵、瑞芬太尼用量、麻醉维持时瑞马唑仑用量,术中失血量、术中补液量、手术时间、拔管时间比较,差异均无统计学意义(P>0.05);与A组比较,B组、C组改良警觉镇静评分(MOAA/S)评分、瑞马唑仑补救率降低(P<0.05),睫毛反射消失时间、麻醉趋势指数(NI)降至D0的时间缩短(P<0.05);与A组、B组比较,C组苏醒时间延长(P<0.05);与A组、B组比较,T_1时C组心率(HR)、平均动脉压(MAP)降低,T_2、T_3、T_4时C组HR、MAP升高(P<0.05);组内:与T_0时比较,T_1、T_4时A组、B组HR、MAP降低(P<0.05),T_2时A组、B组HR、MAP升高(P<0.05);与T_1时比较,T_2、T_3时A组、B组HR、MAP升高(P<0.05);与T_2时比较,T_3、T_4时A组、B组HR、MAP降低(P<0.05);与T_0时比较,T_1时C组HR、MAP降低(P<0.05),T_2、T_3时组HR、MAP升高(P<0.05);与T_1时比较,T_2、T_3、T_4时C组HR、MAP升高(P<0.05);与T_2时比较,T_3、T_4时C组HR、MAP降低(P<0.05);与T_3时比较,T_4时C组HR、MAP降低(P<0.05);与A组、B组比较,C组呼吸抑制发生率升高(P<0.05)。结论 0.3 mg/kg、0.4 mg/kg瑞马唑仑全麻诱导在NSCLC根治性切除术中的镇静效果优于0.2 mg/kg, 0.2 mg/kg、0.3 mg/kg瑞马唑仑苏醒时间短于0.4 mg/kg,对血流动力学的影响及不良反应更小,综合考虑0.3 mg/kg瑞马唑具有更好的效果及安全性。

Objective To compare the application effects of different doses of remimazolam general anesthesia induction in radical resection of non-small cell lung cancer(NSCLC).Methods One hundred and forty-four patients with NSCLC who underwent radical resection in our hospital from January 2021 to June 2023 were selected as study subjects,and they were divided into group A,group B,and group C by computer random number generator,with 48 cases in each group.The anesthesia induction in the three groups was conducted by using remimazolam at the dose of 0.2,0.3,and 0.4 mg/kg,respectively.The intraoperative anesthetic drug dosage,perioperative indicators,sedation effect,recovery time,perioperative hemodynamic indicators(T 1:at the start of induction,T 2:immediately after tracheal intubation,T 3:10 min after tracheal intubation,T 4:at the end of surgery)and adverse reactions of the three groups were compared.Results There were no significant differences in the intraoperative dosage of sufentanil,rocuronium,and remifentanil,remimazolam dosage during anesthesia maintenance,intraoperative blood loss,intraoperative fluid replacement,operation time,and extubation time among the three groups(P>0.05).Compared with group A,the modified observer's assessment of alertness/sedation scale(MOAA/S)score and remimazolam rescue rate of group B and group C were lower(P<0.05),and the time the eyelash reflex disappearance and anesthesia trend index(NI)decreased to D0 were shorter(P<0.05).Compared with group A and group B,the recovery time of group C was longer(P<0.05).Compared with groups A and B,heart rate(HR)and mean arterial pressure(MAP)in group C decreased at T 1 and increased at T 2,T 3,and T 4(P<0.05).Within groups:Compared with T 0,HR and MAP decreased at T 1 and T 4 in groups A and B(P<0.05),and increased at T 2 in groups A and B(P<0.05).Compared with T 1,HR and MAP in groups A and B increased at T 2 and T 3(P<0.05).Compared with T 2,HR and MAP in groups A and B decreased at T 3 and T 4(P<0.05).Compared with T 0,HR and MAP in group C decreased at T 1(P<0.05),and increased at T 2 and T 3(P<0.05).Compared with T 1,HR and MAP increased at T 2,T 3,and T 4 in group C(P<0.05).Compared with T 2,HR and MAP decreased at T 3 and T 4 in group C ( P <0.05).Compared with T 3,HR and MAP decreased at T 4 in group C ( P <0.05).Compared with group A and group B,the respiratory depression incidence of group C were higher ( P <0.05) .Conclusions The sedative effect of 0.3 and 0.4 mg/kg remimazolam for general anesthesia induction in NSCLC radical resection is better than 0.2 mg/kg,the recovery time of 0.2 and 0.3 mg/kg remimazolam is shorter than that of 0.4 mg/kg,and has less impact on hemodynamics and induced less adverse reactions,considering comprehensively,0.3 mg/kg remimazolam has better effect and safety.