瑞马唑仑对心脏瓣膜置换术患者全身麻醉诱导期血流动力学及术后认知功能的影响

Effects of remimazolam on hemodynamics during the induction of general anesthesia and postoperative cognitive function in patients undergoing cardiac valve replacement surgery

目的探讨瑞马唑仑对心脏瓣膜置换术患者全身麻醉诱导期血流动力学及术后认知功能的影响。方法采用随机对照研究,选取2020年1月至2023年12月在延安大学附属医院接受心脏瓣膜置换手术的患者80例,依据随机数字表法分为对照组、观察组各40例。对照组实施常规全身麻醉,观察组在常规麻醉过程中加入瑞马唑仑辅助。对比两组不同时间点的血流动力学指标:麻醉诱导前(T1)、麻醉诱导开始给药时(T2)、麻醉诱导5 min(T3)、气管插管时(T4)、气管插管5 min(T5)的心率及平均动脉压;对比两组麻醉诱导期的麻醉深度;对比两组术前及术后即刻的认知情况;对比两组围术期发生的麻醉相关不良事件。结果观察组T4、T5时间点心率分别为(79.23±10.22)次/min、(78.54±9.94)次/min,平均动脉压分别为(115.64±21.04)mmHg(1 mmHg=0.133 kPa)、(108.61±17.99)mmHg,均低于对照组[心率:(84.51±10.35)次/min、(84.31±10.08)次/min,平均动脉压:(130.06±19.25)mmHg、(121.62±18.61)mmHg](t=2.30、2.58、3.20、3.18,均P<0.05)。观察组脑电双频指数达到低于60的耗时、实施气管插管之前的脑电双频指数均明显低于对照组(t=3.03,3.14,均P<0.05)。手术后即刻,对照组的简易智能量表(MMSE)评分明显降低(t=6.43,P<0.05),观察组的MMSE评分未发生明显的变化(t=0.60,P>0.05),且观察组术后即刻的MMSE评分[(26.98±2.97)分]明显高于对照组[(23.15±2.78)分](t=-5.95,P<0.05)。两组围术期麻醉相关不良事件发生率差异无统计学意义(χ^(2)=0.66,P>0.05)。结论瑞马唑仑可保持心脏瓣膜手术患者麻醉诱导期的血流动力学稳定,有助于快速达到满意的镇静状态,减少术后即时认知功能损伤,且联合使用不会明显增加麻醉风险,安全性较高。

Objective To investigate the effects of remimazolam on hemodynamics during the induction of general anesthesia and postoperative cognitive function in patients undergoing cardiac valve replacement surgery.Methods A randomized controlled study was conducted involving 80 patients who underwent heart valve replacement surgery at Yan'an University Affiliated Hospital from January 2020 to December 2023.The patients were randomly assigned to either a control group or an observation group,with 40 patients in each group.The control group received routine general anesthesia,while the observation group received additional remimazolam during the routine anesthesia process.Hemodynamic parameters were compared between the two groups at different time points:heart rate and mean arterial pressure were recorded before anesthesia induction(T1),at the beginning of anesthesia induction(T2),5 minutes after anesthesia induction(T3),at the time of tracheal intubation(T4),and 5 minutes after tracheal intubation(T5).The level of anesthesia during induction was compared between the two groups.Cognitive function in both groups was evaluated before and immediately after surgery.Additionally,the incidence of anesthesia-related adverse events during the perioperative period was compared between the two groups.Results At T4 and T5,the heart rates in the observation group were(79.23±10.22)beats/min and(78.54±9.94)beats/min,respectively,and the mean arterial pressures were(115.64±21.04)mmHg(1 mmHg=0.133 kPa)and(108.61±17.99)mmHg.Both values were significantly lower than those in the control group[heart rate:(84.51±10.35)beats/min,(84.31±10.08)beats/min,mean arterial pressure:(130.06±19.25)mmHg,(121.62±18.61)mmHg,t=2.30,2.58,3.20,3.18,all P<0.05].The time taken for the EEG bi-frequency index to drop below 60 and the EEG bi-frequency index before tracheal intubation in the observation group were both significantly lower than those in the control group(t=3.03,3.14,both P<0.05).Immediately after surgery,the Mini-Mental State Examination(MMSE)score in the control group showed a significant decrease(t=6.43,P<0.05),while the MMSE score in the observation group did not change significantly(t=0.60,P>0.05).Moreover,the immediate postoperative MMSE score in the observation group[(26.98±2.97)points]was significantly higher than that in the control group[(23.15±2.78)points,t=-5.95,P<0.05].There was no statistically significant difference in the incidence of anesthesia-related adverse events between the two groups(χ^(2)=0.66,P>0.05).Conclusion Remimazolam can maintain hemodynamic stability during the induction of anesthesia in patients undergoing cardiac valve replacement surgery,facilitate the rapid attainment of satisfactory sedation,and reduce immediate postoperative cognitive dysfunction.Furthermore,the use of remimazolam in conjunction with routine general anesthesia does not significantly increase anesthesia-related risks,demonstrating a high level of safety.