瑞马唑仑对全身麻醉下日间玻璃体视网膜切除术糖尿病视网膜病变患者的效果观察

Observation on anesthetic effect of remimazolam on diabetic retinopathy patients undergoing daytime pars plana vitrectomy under general anesthesia

目的探讨瑞马唑仑和丙泊酚对行全身麻醉下日间玻璃体视网膜切除术(pars plana vitrectomy,PPV)的糖尿病视网膜病变(diabetic retinopathy,DR)患者血流动力学变化和恢复质量的影响。方法选取2022年11月至2023年6月首都医科大学附属北京同仁医院行日间PPV的DR患者60例,采用随机数字表法分为丙泊酚组与瑞马唑仑组,每组30例。麻醉诱导时,丙泊酚组静脉注射丙泊酚1~2 mg/kg,瑞马唑仑组静脉注射瑞马唑仑0.2~0.3 mg/kg,两组均给予舒芬太尼0.2μg/kg,待患者意识消失后给予顺阿曲库铵0.2 mg/kg,置入喉罩后行机械通气。麻醉维持时,两组分别泵注丙泊酚4~8 mg/(kg·h)或瑞马唑仑0.3~1 mg/(kg·h),维持脑电双频指数40~60,同时静脉泵注瑞芬太尼,间断推注顺阿曲库铵。术毕待患者意识清醒及自主呼吸恢复后拔除喉罩送至麻醉恢复室观察。比较两组患者入室后、诱导后、置入喉罩时、手术开始时、手术开始后30 min、手术结束时和拔除喉罩时等不同时间点血流动力学变化、恢复质量及不良反应发生情况。结果60例患者中,男25例、女35例,年龄34~75岁,平均(54.3±10.0)岁。诱导后、置入喉罩时及手术开始后30 min,瑞马唑仑组的MAP均高于丙泊酚组,麻黄碱使用率、苏醒时Ramsay镇静评分及躁动程度评分(restless⁃ness score,RS)均低于丙泊酚组,差异有统计学意义(P<0.05)。两组各时间点HR、苏醒时间、拔除喉罩时间、PACU停留时间及术后不良反应发生率的比较,差异均无统计学意义(P>0.05)。结论与丙泊酚相比,行日间PPV的DR患者使用瑞马唑仑时,患者术中血流动力学更加平稳,苏醒质量更高。

Objective To explore the effects of remimazolam and propofol on hemodynamic changes and quality of recovery of diabetic retinopathy(DR)patients undergoing pars plana vitreoretinopathy(PPV)under general anesthesia.Methods A total of 60 patients who underwent daytime PPV due to DR in Beijing Tongren Hospital,Capital Medical University from November 2022 to June 2023 were selected,and were randomly divided into propofol groups and remimazolam group,with 30 patients in each group.During anesthesia induction,propofol group was given 1-2 mg/kg intravenously,while remimazolam group was given 0.2-0.3 mg/kg intravenously,sufentanil was given 0.2μg/kg in both groups,and cisatracurium was given 0.2 mg/kg after the patient's consciousness disappeared,and mechanical ventilation was performed after laryngeal mask implantation.During the maintenance of anesthesia,propofol 4-8 mg/(kg·h)or remimazolam 0.3-1 mg/(kg·h)were pumped in the two groups respectively,and the bispectral index was maintained at 40-60,while remifentanil was pumped intravenously and cisatracurium was intermittently injected.After the surgery,when the patient regained consciousness and autonomous breathing,the laryngeal mask was removed and patients were sent to the anesthesia recovery room for observation.The hemodynamic changes,recovery quality and adverse reactions were compared between the two groups at different time points,such as after entering the room,after induction,when laryngeal mask was inserted,at the beginning of operation,30 min after operation,at the end of operation and when laryngeal mask was removed.Results Among the 60 patients,there were 25 males and 35 females,aged from 34 to 75 years,with an average age of(54.3±10.0)years.The MAP of remimazolam group were higher than those of propofol group at the time of after induction,laryngeal mask implantation and 30 min MAP after operation,and the ephedrine usage rate,Ramsay sedation score and restlessness score(RS)were lower than those of propofol group,and the differences were statistically significant(all P<0.05).There were no statistically significant differences in HR,awakening time,removal time of laryngeal mask,PACU stay time,and incidence of postoperative adverse reactions between the two groups at different time points(all P>0.05).Conclusions Compared with propofol,remimazolam used for daytime PPV anesthesia in patients with DR has stable hemodynamics and higher quality of recovery during daytime surgery.