不同剂量瑞马唑仑对宫腔镜手术患者镇静镇痛效果

Sedation and analgesia effect of the different doses of remrazolam used during hysteroscopic surgery of patients

目的:探讨宫腔镜手术不同剂量瑞马唑仑镇静镇痛效果及其不良反应差异。方法:将2020年9月-2022年7月本院妇产科收治的90例宫腔镜手术患者随机分为3组各30例,均予以舒芬太尼0.2μg/kg+瑞马唑仑0.2mg/kg进行麻醉诱导,分别予以0.5mg/kg/h(低剂量组)、1.0mg/kg/h(中剂量组)、1.5mg/kg/h(高剂量组)瑞马唑仑进行麻醉维持。观察3组麻醉指标(麻醉起效时间、苏醒时间)、镇静效果(BIS控制时间、BIS值)、应激反应指标[皮质醇(Cor)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)]、补救镇痛率与苏醒期躁动发生率、不良反应(术中体动、呼吸抑制、恶心呕吐、低血压)。结果:3组麻醉起效时间无差异(P>0.05),苏醒时间中剂量组(557.26±141.47s)、高剂量组(550.25±139.93s)长于低剂量组(388.34±103.34s)(均P<0.05);3组BIS值无差异(P<0.05),BIS控制时间高剂量组(48.93±81.15s)、中剂量组(63.64±9.11s)、低剂量组(75.52±12.24s)依次升高(P<0.05);中剂量组、高剂量组血Cor、CRP、IL-6水平均低于低剂量组,补救镇痛率(16.7%、13.3%)与苏醒期躁动发生率(10.0%、6.7%)均低于低剂量组(43.3%、33.3%)(均P<0.05)。3组不良反应发生率(26.7%、20.0%、16.7%)无差异(P>0.05)。结论:宫腔镜手术不同剂量瑞马唑仑在患者麻醉维持中的应用效果存在差异,1.0mg/kg/h瑞马唑仑麻醉维持可满足手术要求,镇静镇痛效果较好,且患者应激反应轻微,不良反应少。

Objective: To explore the effect of the different doses of remrazolam for sedation and analgesia during hysteroscopic surgery of patients, and to study the differences of the adverse reactions of the patients. Methods: 90 patients who wanted hysteroscopic surgery in the obstetrics and gynecology department of the hospital were randomly divided into three groups(30 cases in each group) from September 2020 to July 2022. All the patients in the three groups were given sufentanil 0.2μg/kg and remimazolam 0.2mg/kg for anesthesia induction, and then the patients in group A, in group B and in group C were given 0.5mg/kg/h, 1.0mg/kg/h, and 1.5mg/kg/h remimazolam for anesthesia maintained, respectively. The values of anesthesia indicators, such as anesthesia onset time and awakening time, the values of sedation effect, such as BIS control time and BIS value, the levels of stress response indicators, such as Cortisol(Cor), C-reactive protein(CRP) and interleukin 6(IL-6), and the rates of the rescue analgesia and restlessness during awakening, and the rate of adverse reactions, such as intraoperative physical activity, respiratory depression, nausea and vomiting and hypotension of the patients in three groups were observed. Results: There was no significant difference in the anesthesia on-set time of the patients among the three groups(P>0.05). The awaking time of the patients in group B(557.26±141.47 s) or in group in C(550.25±139.93 s) was significantly longer than that(388.34±103.34 s) of the patients in group A(all P<0.05). There was no significant difference in the BIS value of the patients among the three groups(P<0.05). The BIS control time of the patients in group C(48.93±81.15 s), in group B(63.64±9.11 s), and in group A(75.52±12.24 s) had increased gradually(P<0.05). The levels of serum Cor, CRP and IL-6of the patients in group B and in group C were significantly lower than those of the patients in group A.The incidence of rescue analgesia of the patients in group B and group C(16.7% and 13.3%)and the incidence of agitation during awaking of the patients in group B and group C(10.0% and 6.7%)were significantly lower than those(43.3%and 33.3%)of the patients in group A(all P<0.05).There was no significant difference in the incidence of the adverse reactions(26.7% vs.20.0% vs.16.7%)of the patients among the three groups(P>0.05).Conclusion:There are differences in the application effect of the different doses of remrazolam for the anesthesia maintenance during hysteroscopic surgery of the patients.1.0mg/kg/h remrazolam used for anesthesia maintenance can meet the surgical requirement,which has better sedative and analgesic effect,and has mild stress reactions of the patients,with fewer adverse reactions.