右美托咪定、瑞马唑仑在胸腔镜手术非气管插管全身麻醉中效果的比较

Comparison of the effects of dexmedetomidine and remazolam on general anesthesia without endotracheal intubation during thoracoscopic surgery

目的探讨右美托咪定、瑞马唑仑在胸腔镜手术非气管插管全身麻醉中的应用价值。方法选取2022年1月—2024年1月拟行胸腔镜手术的患者74例作为研究对象,用随机数字表法分为右美托咪定组和瑞马唑仑组,每组37例。2组均采取非气管插管全身麻醉,右美托咪定组用右美托咪定进行麻醉,瑞马唑仑组用瑞马唑仑进行麻醉。比较2组心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、神经递质[神经特异蛋白(neural specific protein,S100β)蛋白、神经元烯醇化酶(neuronspecific enolase,NSE)、脑源性神经营养因子(brain derived neurophic factor,BDNF)]、麻醉效果、恢复质量及不良反应的发生情况。结果与入室时(t_(0))比较,2组麻醉诱导后(t_(1))MAP、HR均较低,手术开始(t_(2))、手术结束(t3)时的MAP、HR较高,时间点及组间-时间点比较差异均有统计学意义(P<0.05)。2组血清S100β、NSE、BDNF水平组间、时间点、组间-时间点比较差异均有统计学意义(P<0.05);术后3 d,2组的血清S100β、NSE均高于术前,BDNF低于术前,差异均有统计学意义(P<0.05);术后3 d,瑞马唑仑组的血清S100β、NSE均低于右美托咪定组,BDNF高于右美托咪定组,差异均有统计学意义(P<0.05)。右美托咪定组和瑞马唑仑组的麻醉效果比较差异无统计学意义(P>0.05)。瑞马唑仑组苏醒时间、镇静深度达标时间均短于右美托咪定组(P<0.05)。右美托咪定组呼吸抑制发生率低于瑞马唑仑组(P<0.05)。结论瑞马唑仑与右美托咪定能改善非气管插管全身麻醉患者的生命体征,麻醉效果较好,但瑞马唑仑对患者神经递质指标的改善更为明显,苏醒时间、镇静深度达标所需时间较短,体动抑制发生率较低,更有助于患者的术后恢复。

Objective To explore the application value of dexmedetomidine and remazolam on general anesthesia without endotracheal intubation during thoracoscopic surgery.Methods A total of 74 patients scheduled for thoracoscopic surgery from January 2022 to January 2024 were selected as study subjects and randomly divided into a dexmedetomidine group and a remazolam group using a random number table method,with 37 cases in each group.Both groups underwent general anesthesia without endotracheal intubation.The dexmedetomidine group was anesthetized with dexmedetomidine,while the remazolam group was anesthetized with remazolam.The heart rate(HR),mean arterial pressure(MAP),neurotransmitters[neural specific protein(S100β),neuronspecific enolase(NSE),the brain-derived neurotrophic factor(BDNF)],anesthesia efficacy,recovery quality,and the incidence of adverse reactions were compared between the 2 groups.Results Compared with the time point of entering the room(t_(0)),both MAP and HR were lower in both groups after anesthesia induction(t_(1)),while the MAP and HR were higher at the start of surgery(t_(2))and at the end of surgery(t_(3)).There were statistically significant differences in time points and between-group-time point comparisons(P<0.05).There were statistically significant differences in serum levels of S100β,NSE,and BDNF between the 2 groups,at time points,and between-group-time point comparisons(P<0.05).Three days after surgery,the serum levels of S100βand NSE were higher in both groups than before surgery,while the BDNF levels were lower,with statistically significant differences(P<0.05).Three days after surgery,the serum levels of S100βand NSE were lower in the remazolam group than in the dexmedetomidine group,while the BDNF levels were higher,with statistically significant differences(P<0.05).There was no statistically significant difference in anesthesia efficacy between the dexmedetomidine group and the remazolam group(P>0.05).The recovery time and sedation depth achievement time in the remazolam group were shorter than those in the dexmedetomidine group(P<0.05).The incidence of respiratory depression in the dexmedetomidine group was lower than that in the remazolam group(P<0.05).Conclusion Remazolam and dexmedetomidine can improve vital signs in patients undergoing general anesthesia without endotracheal intubation,with good anesthetic effects.However,remazolam shows a more significant improvement in neurotransmitter indicators,with shorter recovery time and time required to achieve desired sedation depth,and a lower incidence of body movement inhibition,which is more conducive to postoperative recovery for patients.