甲磺酸瑞马唑仑麻醉对腹腔镜子宫切除术患者炎症应激反应和认知功能的影响

Influence of remimazolam mesylate anesthesia during laparoscopic hysterectomy of patients on their inflammatory stress response and cognitive function

目的:探究甲磺酸瑞马唑仑麻醉对腹腔镜子宫切除术患者炎症应激反应和认知功能的影响。方法:纳入2021年8月-2023年1月本院收治拟行腹腔镜子宫切除术患者85例,信封法随机分为瑞马唑仑组(n=46例,甲磺酸瑞马唑仑麻醉)和丙泊酚组(n=39例,丙泊酚麻醉)。比较两组术前未麻醉时(T0)、麻醉后5 min(T1)、气管插管后10 min(T2)、拔管后即刻(T3)和手术结束前5 min时(T4)的血流动力学指标[心率(HR)、收缩压(SBP)和舒张压(DBP)],术前1 h和术后12 h炎症应激指标[白介素(IL-6)、C蛋白反应(CRP)、肿瘤坏死因子(TNF-α)、去甲肾上腺素(NE)水平],认知能力[蒙特利尔认知评估(MoCA)分数、简明精神状态(MMSE)评分]以及术后不良发生率。结果:瑞马唑仑组HR水平在T3(86.6±7.4次/min)、T4(78.6±6.2次/min)均低于丙泊酚组(94.1±7.0次/min、82.6±6.9次/min),SBP水平T3时(132.9±7.1mmHg)高于丙泊酚组(128.5±6.8mmHg),DBP在T3、T4时(78.6±6.8mmHg、80.3±8.3mmHg)高于丙泊酚组(85.6±6.0mmHg、85.7±8.8mmHg)(均P<0.05)。瑞马唑仑组术后12 h,IL-6、CRP、TNF-α和NE水平(92.87±13.75ng/L、15.61±2.99mg/L、7.42±1.96ng/ml、74.14±11.96ng/L)均低于丙泊酚组(121.81±13.99ng/L、18.79±3.67mg/L、8.76±2.17ng/ml、82.57±15.53ng/L),术后3 d MoCA(29.85±1.66分)和MMSE(29.46±1.11分)均高于丙泊酚组(28.92±1.36分、28.62±1.06分),不良反应发生率(19.6%)低于丙泊酚组(41.0%)(均P<0.05)。结论:腹腔镜子宫切除术应用甲磺酸瑞马唑仑麻醉对患者有稳定血流动力学、改善炎症应激负荷、保护认知的功效。

Objective:To explore the influence of remimazolam mesylate anesthesia during laparoscopic hysterectomy of patients on their inflammatory stress response and cognitive function.Methods:85 patients who wanted laparoscopic hysterectomy were enrolled and were randomly divided into observation group(46 patients with remimazolam mesylate anesthesia)and control group(39 patients with propofol anesthesia)by the envelope random method from August2021 to January 2023.The values of hemodynamic indicators,such as heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)before anesthesia(T0),at 5 min after anesthesia(T1),at 10 min after tracheal intubation(T2),immediately after extubation(T3)and at 5 min before the end of surgery(T4),the levels of inflammatory stress indicators,such as interleukin(IL-6),C-reactive protein(CRP),tumor necrosis factor(TNF-α)and norepinephrine(NE),the scores of cognitive ability by Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)at 1h before surgery and at 12 h after surgery,and the incidence rate of the postoperative adverse reactions of the patients were compared between two groups.Results:The HR values of the patients in the observation group at T3(86.6±7.4 times/min)and at T4(78.6±6.2 times/min)were significantly lower than those(94.1±7.0 times/min and 82.6±6.9 times/min)of the patients in the control group.The SBP value(132.9±7.1mmHg)of the patients in the observation group at T3 was significantly higher than that(128.5±6.8mmHg)of the patients in the control group.The DBP value of the patients in the observation group at T3(78.6±6.8mmHg)and at T4(80.3±8.3mmHg)were significantly higher than those(85.6±6.0mmHg and 85.7±8.8mmHg)of the patients in the control group(all P<0.05).The levels of IL-6,CRP,TNF-αand NE(92.87±13.75ng/L,15.61±2.99mg/L,7.42±1.96ng/ml and 74.14±11.96ng/L)of the patients in the observation group in 12 hours after operation were significantly lower than those(121.81±13.99ng/L,18.79±3.67mg/L,8.76±2.17ng/ml and 82.57±15.53ng/L)of the patients in the control group.The scores of MoCA(29.85±1.66 points)and MMSE(29.46±1.11 points)of the patients in the observation group in 3 days after surgery were significantly higher than those(28.92±1.36 points and28.62±1.06 points)of the patients in the control group.The incidence of the adverse reactions(19.6%)of the patients in the observation group was significantly lower than that(41.0%)of the patients in the control group(all P<0.05).Conclusion:Remimazolam mesylate anesthesia during laparoscopic hysterectomy of the patients has the effect of stabilizing their hemodynamics,improving their inflammatory stress load and protecting their cognition.