苯磺酸瑞马唑仑对甲状腺癌根治术患者的影响及作用机制研究

Effects and mechanism of remimazolam besylate on patients undergoing radical thyroidec⁃tomy

目的探究苯磺酸瑞马唑仑对甲状腺癌根治术患者的影响及作用机制。方法选取2022年4月至2023年5月在青岛市城阳区人民医院行甲状腺癌根治术的患者147例,按随机数表法对入组患者进行分组,分为研究组(麻醉诱导期给与苯磺酸瑞马唑仑+舒芬太尼+苯磺阿曲库铵)74例、对照组(麻醉诱导期给与丙泊酚+舒芬太尼+苯磺阿曲库铵)73例,比较两组患者不同时间[术前(T_(0))、麻醉后1 min(T_(1))、麻醉后5 min(T_(2))、气管插管时(T_(3))、麻醉后1h(T_(4))、麻醉后2 h(T_(5))、苏醒时(T_(6))]的术中体征;比较两组患者的术后恢复情况、炎症应激指标、JAK/STAT信号通路分子表达水平以及不良反应发生率。结果两组患者的平均动脉压(MAP)、心率(HR)差异均有统计学意义(MAP:F_(研究组)=78.227,F_(对照组)=28.302;HR:F_(研究组)=17.393,F_(对照组)=4.332,P<0.05),研究组T_(1~3)时MAP高于对照组,T_(2~4)时HR高于对照组,差异均有统计学意义(P<0.05);两组患者术后意识恢复、拔管时间、定向力回复时间、拔管后Ramsay镇静评分差异无统计学意义(P>0.05);两组患者术后血清肾上腺素(E)、去甲肾上腺素(NE)及肿瘤坏死因子α(TNF⁃α)、白介素(IL)6、IL⁃10、JAK2、STAT_(3)水平均升高(均P<0.05),且研究组均低于对照组(P<0.05);两组总不良反应发生率差异无统计学意义(P>0.05)。结论苯磺酸瑞马唑仑对甲状腺癌根治术患者具有较好的麻醉镇静效果,亦能够减轻患者术后应激反应和炎症反应,其机制可能与调控JAK/STAT信号通路相关。

Objective To explore the effects and mechanism of remazolam besylate on patients un-dergoing radical thyroidectomy.Methods 147 patients who underwent radical thyroidectomy at Qingdao Chengyang People’s Hospital from April 2022 to May 2023 were selected and grouped using the random num-ber table method.The study group consisted of 74 cases(remimazolam besylate+sufentanil+atracurium besi-late during anesthesia induction),while the control group had 73 cases(propofol+sufentanil+atracurium besi-late during anesthesia induction).Intraoperative signs were recorded at different time points:before surgery(T_(0)),1 minute after anesthesia(T_(1)),5 minutes after anesthesia(T_(2)),at endotracheal intubation(T_(3)),1 hour after anesthesia(T_(4),),2 hours after anesthesia(T_(5)),and at recovery(T_(6)).Additionally,postoperative recov-ery status,inflammatory stress indicators,JAK/STAT signaling pathway molecules,incidence rates of adverse reactions were compared between the two groups.Results There were statistical differences in mean arterial pressure(MAP)and heart rate(HR)between groups(MAP:F_(studygroup)=78.227,F_(controlgroup)=28.302;HR:F_(studygroup)=17.393,F_(controlgroup)=4.332,P<0.05).The MAP in the study group at T_(1-3) was higher than that in the con-trol group,and the HR at T_(2-4) was also higher than that in the control group(P<0.05).There were no statistical differences in postoperative consciousness recovery time,extubation time,orientation recovery time and Ram-say sedation score after extubation between the two groups(P>0.05).The difference in VAS score from the as-pect of time-point was statistically significant(P<0.05).The levels of serum epinephrine(E),norepinephrine(NE),tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-10,JAK and STAT in both groups increased after surgery(P<0.05),and the levels in the study group after surgery were lower than those in the control group(P<0.05).There was no statistical difference in the total incidence rate of adverse reactions between the two groups(P>0.05).Conclusion Remimazolam besylate has a strong anesthetic and sedative effect on pa-tients undergoing radical thyroidectomy.It can help to alleviate the postoperative stress response and inflamma-tory response.The mechanism of action may be related to the regulation of the JAK/STAT signaling pathway.