高原地区全身麻醉诱导期瑞马唑仑的应用研究——以西藏大学附属阜康医院为例

Research on the application of remimazolamin the induction period of general anesthesia in the plateau area——Taking Xizang University Affiliated Fukang Hospital as an Example

目的观察高原地区藏族成年患者全身麻醉诱导期应用瑞马唑仑的镇静效果及血流动力学的变化。方法选择2023年6—9月全身麻醉下择期手术患者120例、年龄18~60岁、性别不限、BMI 20~25 kg/m^(2),ASAⅠ~Ⅱ级。随机数字表法将120例患者均分三组(n=40):丙泊酚组(P组)、瑞马唑仑1组(R1组)和瑞马唑仑2组(R2组)。缓慢静脉注射P组丙泊酚2mg/kg;R1组瑞马唑仑0.3mg/kg;R2组瑞马唑仑0.4mg/kg,阿芬太尼20μg/kg、罗库溴铵0.6mg/kg静脉麻醉诱导。监测记录麻醉诱导前(T_(0))、镇静起效后(T_(1))、气管插管前(T_(2))以及气管插管后第1min(T_(3))、第3min(T_(4))、第5min(T_(5))时点的SBP、MAP、DBP、HR、BIS和SpO2,以及改良MOAA/S 1分的时间、BIS镇静起效时间。比较三组间不同时点血流动力学指标的变化以及低血压、窦性心动过缓、注射痛、镇静补救和术中知晓等不良事件的发生情况。结果三组间一般情况比较无统计学差异。组内与T_(0)时点比较,3组T_(1)~T_(5)时点SBP、MAP、DBP、BIS均降低(P<0.05)。组间与P组比较,R1组T_(1)~T_(5)时点、R2组T_(4)~T_(5)的SBP与P组比较差异有统计学意义(P<0.05),R1、R2组T_(1)~T_(5)时点的HR与P组比较均有统计学意义(P<0.05)。R1组T_(1)~T_(3)时点BIS与P组比较有统计学意义(P<0.05)。P组、R1组、R2组三组低血压发生率为65.0%、30.0%、37.5%(χ^(2)=11.017,P=0.004);窦性心动过缓发生率分别为55.0%、32.5%、27.5%(χ^(2)=7.262,P=0.026);静脉注射痛发生率分别为70.0%、25.0%、20.0%(χ^(2)=25.66,P=0.000);BIS 60所需时间(秒)分别为73.2±10.4,82.7±14.5,73.4±14.0(t=3.965,P=0.030);MOAA/S 1所需时间(秒)分别为62.8±9.7,69.4±9.0,57.3±11.4(t=2.408,P=0.098)。三组患者均未发生术中知晓。结论高原藏族成年患者应用瑞马唑仑全身麻醉静脉诱导时安全有效,血流动力学稳定。

Objective To observe the sedative effect and hemodynamic changes of remimazolam in adult Tibetan patients in the plateau area during the induction period of general anesthesi.Methods A total of 120 patients were selected,following a series of critera including undergoing elective surgery under general anesthesia from June to September 2023,aged 18~60 years,male or female,with a BMI of 20~25 kg/m^(2)and ASA grades I~II.120 patients were evenly divided into three groups(n=40)by a random number table method:propofol group(P group),remimazolam 1 group(R1 group),and remimazolam 2 group(R2 group).Slow intravenous injections were given to the three groups that P group received propofol 2mg/kg,R1 group received remimazolam 0.3mg/kg,and R2 group received remimazolam 0.4mg/kg with afentanil 20μg/kg and rocuronium bromide 0.6mg/kg for intravenous anesthesia induction.Monitoring records the data of the SBP,MAP,DBP,HR,BIS,and SpO2 before anesthesia induction(T_(0)),after sedation onset(T_(1)),before endotracheal intubation(T_(2)),and 1 minute(T_(3)),3 minutes(T4),and 5 minutes(T_(5))after endotracheal intubation,as well as the modified MOAA/S 1min and BIS sedation onset time.The changes in hemodynamic indicators at different time points and the occurrence of adverse events such as hypotension,sinus bradycardia,injection pain,sedation relief,and intraoperative awareness were compared among the three groups.Results There were no statistically significant differences among the three groups.Compared with T_(0),SBP,MAP,DBP,and BIS decreased in the three groups from T_(1)to T_(5)(P<0.05).Compared with P group,there were statistically significant differences in SBP at T_(1)~T_(5)in R1 group and T4~T_(5)in R2 group(P<0.05),and HR at T_(1)~T_(5)in R1 and R2 groups(P<0.05).There was a statistically significant difference in BIS at T_(1)~T_(3)between P group and R1 group(P<0.05).The incidence rates of hypotension in the P,R1,and R2 groups were 65.0%,30.0%,and 37.5%(χ^(2)=11.017,P=0.004);the incidence rates of sinus bradycardia were 55.0%,32.5%,and 27.5%respectively(χ^(2)=7.262,P=0.026);the incidence rates of intravenous injection pain were 70.0%,25.0%,and 20.0%respectively(χ^(2)=25.66,P=0.000);the time(seconds)required for BIS 60 were 73.2±10.4,82.7±14.5,and 73.4±14.0(t=3.965,P=0.030)respectively;and the time(seconds)required for MOAA/S 1 were 62.8±9.7,69.4±9.0,and 57.3±11.4(t=2.408,P=0.098)respectively.No intraoperative awareness occurred among the three groups.Conclusion The use of remimazolam for the intravenous induction of general anesthesia in adult Tibetan patients in the plateau area is safe,effective,and hemodynamically stable.