宫腔镜手术苯磺酸瑞马唑仑联合瑞芬太尼麻醉效果及对患者术后认知功能影响

Effect of the combination of remazolam besylate and remifentanil used during hysteroscopic surgery of patients and its influence on the postoperative cognitive function

目的:探讨苯磺酸瑞马唑仑联合瑞芬太尼对宫腔镜手术麻醉效果及对患者认知功能影响。方法:将2021年12月-2023年12月在本院妇科收治的宫腔镜手术患者90例随机分为两组各45例,分别予以丙泊酚联合瑞芬太尼麻醉(对照组)、苯磺酸瑞马唑仑联合瑞芬太尼麻醉(观察组)。观察两组麻醉指标、苏醒时间、术后疼痛、术后认知功能、血清血小板活化因子(PAF)和γ干扰素(IFN-γ)、不良反应。结果:观察组麻醉诱导时间(74.3±7.3 s)、瑞芬太尼剂量(183.3±22.6μg)、呼吸恢复(6.2±1.1 min)、拔管(7.9±1.2 min)、睁眼(14.2±2.4 min)、定向力恢复(13.6±2.2 min)等时间均少于对照组(85.9±6.4 s、211.8±25.9μg、8.1±1.3 min、11.0±2.1 min、16.7±2.1 min、16.7±2.4 min),术后3、6、12、24h的患者疼痛VAS评分低于对照组,术后3、6、12h患者认知功能MMSE评分(20.45±1.97分、24.59±2.20分、27.89±1.67分)均高于对照组(18.46±2.05分、23.47±2.14分、27.24±1.83分),两组术后24h的PAF升高、IFN-γ降低但观察组变化幅度小于对照组,不良反应发生率观察组(6.7%)低于对照组(22.2%)(均P<0.05)。结论:苯磺酸瑞马唑仑联合瑞芬太尼用于宫腔镜手术麻醉效果较好,具有麻醉诱导时间短、苏醒快的优势,且能减轻患者术后疼痛,对认知功能及血清学指标影响轻微,不良反应少,有效性与安全性兼具。

Objective:To explore the effect of the combination of remazolam besylate and remifentanil used during hysteroscopic surgery of patients-and to study it influence on the postoperative cognitive function of the patients.Methods:90 patients who wanted hysteroscopic surgery were randomly divided into two groups from December 2021 to December 2023.45 patients in control group received anesthesia by propofol combined with remifentanil,while 45 patients in observation group received anesthesia by remazolam besylate combined with remifentanil.The anesthesia indicators values-the awakening time-the postoperative pain situation and cognitive function,the levels of serum platelet activating factor(PAF) and Interferon-γ(IFN-γ),and the adverse reactions of the patients in the two groups were observed.Results:The anesthesia induction time(74.3±7.3s),the dose of remifentanil used(183.3±22.6μg),the time of breathing recovery(6.2±1.1 min),the extubation time(7.9±1.2 min),the time of eye opening(14.2±2.4 min) and the time of orientation recovery(13.6±2.2 mm) of the patients in the observation group were significantly less than those(85.9±6.4s,211.8±25.9 μg,8.1±1.3 min,11.0±2.1 min,16.7±2.1 min and 16.7±2.4 min) of the patients in the control group.The pain score by VAS of the patients in the observation group at 3h,6h,12h and 24h after operation were significantly lower than those of the patients in the control group.The MMSE score of the patients in the observation group at 3h,6h and 12h after operation(20.45±1.97 points,24.59±2.20 points and 27.89±1.67 points)were significantly higher than those(18.46±2.05 points,23.47±2.14 points and 27.24±1.83 points) of the patients in the control group.At 24h after operation,the PAF level of the patients in the two groups had increased significantly and the IFN-γ level of the patients in the two groups had decreased significantly,but the changes of which of the patients in the observation group were significantly less than those of the patients in the control group.The incidence of the adverse reactions(6.7%) of the patients in the observation group was significantly lower than that(22.2%) of the patients in the control group(all P<0.05).Conclusion:The combination of remazolam besylate and remifentanil used during hysteroscopic surgery of the patients has good anesthetic effect,has the advantages of the shorter induction time and faster recovery,can reduce postoperative pain of the patients,has a slight impact on the cognitive function and the serological indicators,and has fewer adverse reactions of the patients,and which it is both effective and safe.