瑞马唑仑对老年人全麻下腹腔镜术中应激反应影响的研究

The Effect of Remazolam on Stress Response in the Elderly Patients Underwent Laparoscopic Surgery with General Anesthesia

目的探讨瑞马唑仑对老年人全麻下腹腔镜术中应激反应影响。方法本研究拟选取择期行腹腔镜胆囊切除术的老年患者,随机分为丙泊酚组(P组)和甲苯磺酸瑞马唑仑组(R组)。P组采用丙泊酚麻醉诱导和维持,R组静脉注射甲苯磺酸瑞马唑仑0.3 mg/kg实施麻醉诱导,术中以0.5~1.5 mg/kg/h速度持续泵注维持麻醉,两组患者术中均使用BIS监测麻醉深度,维持BIS值在40~60之间。比较两组患者镇静药起效时间、苏醒时间,麻醉和手术各时段的心率(HR)和平均动脉压(MAP)、血糖(Glu)、肾上腺素(E)、去甲肾上腺素(NE)等指标,以及不良反应(注射痛、术中知晓、术后谵妄等)发生率。结果与T0时比较,T2、T3时P组患者心率明显降低,且P组明显低于R组(P<0.05);T1时P组患者BIS明显低于R组(P<0.05);T0时P组患者MAP明显高于R组(P<0.05);与T0时比较,T2时P组血糖浓度明显升高,且R组明显低于P组(P<0.05);与T0时比较,T2、T4时P组E浓度明显高于R组;与T0时比较,T2时P组NE浓度明显升高,且R组明显低于P组(P<0.05);T2、T4时三组Cor浓度均明显升高(P<0.05)且R组Cor浓度明显低于P组(P<0.05);P组患者注射痛发生率明显高于R组(P<0.05)。结论明确甲苯磺酸瑞马唑仑对老年患者全麻下腹腔镜手术术中应激反应及血流动力学的影响,为甲苯磺酸瑞马唑仑更好地应用于临床提供理论依据。

Objective To investigate the effect of remazolam on stress response in the elderly during laparoscopic surgery under undergoing laparoscopic cholecystectomy were randomly divided into propofol group(group P)and remazolam toluene sulfonate group(group R).Methods Group P was induced and maintained by propofol,group R was induced by intravenous injection of remazolam toluene sulfonate 0.3 mg/kg,and the anesthesia was maintained by continuous pumping at a rate of 0.5-1.5 mg/kg/h during the operation.BIS was used to monitor the depth of anesthesia in both groups during the operation,and the BIS value was maintained between 40 and 60.The onset time of sedation,recovery time,heart rate(HR),mean arterial pressure(MAP),blood glucose(Glu),epinephrine(E),norepinephrine(NE)and other indicators during anesthesia and operation were compared between the two groups,as well as the incidence of adverse reactions(injection pain,intraoperative awareness,postoperative delirium,ete.).Results Compared with TO,the heart rate of patients in group P decreased significantly at T2 and T3,and group P was significantly lower than group R(P<0.05).At T1,BIS in group P was significantly lower than that in group R(P<0.05)At T0,the MAP in group P was significantly higher than that in group R(P<0.05).Compared with T0,the blood glucose concentration in group P was significantly higher at T2,and that in group R was significantly lower than that in group P(P<0.05).Compared with T0,E concentration in group P was significantly higher than that in group R at T2 and T4.Compared with T0,NE concentration in group P was significantly increased at T2,and NE concentration in group R was significantly lower than that in group P(P<0.05).At T2 and T4,the Cor concentration of the three groups was significantly increased(P<0.05),and the Cor concentration of the R group was significantly lower than that of the P group(P<0.05).Conclusions To investigate the effcts of remazolam toluene sulfonate on stress response and hemodynamics in elderly patients undergoing laparoscopic surgery under general anesthesia,and to provide theoretical basis for better clinical application of remazolam toluene sulfonate.