瑞马唑仑在机械通气脓毒症患者中的应用探讨

Application of Remimazolam in Patients with Mechanical Ventilation Sepsis

目的探讨瑞马唑仑在机械通气脓毒症患者中的应用效果。方法根据随机投币法将于2021年4月至2023年4月期间接受机械通气治疗的80例脓毒症患者分为瑞马唑仑组(n=27)、咪达唑仑组(n=27)和右美托咪组(n=26)。比较3组患者的镇静效果(RASS评分、浅镇静达标时间、浅镇静达标率),记录3组给药前、给药后即刻、给药后1 h和给药后6 h的平均动脉压和心率变化,以及给药前、给药后24 h和给药后72 h的炎性应激反应(白介素-1、白介素-6、皮质醇)变化,并统计不良反应(低血压、呼吸抑制、心动过缓)发生情况。结果3组患者的Richmond躁动-镇静评分、浅镇静达标时间及浅镇静达标率比较,差异有统计学意义(P<0.05),且瑞马唑仑组的Richmond躁动-镇静评分及浅镇静达标时间最低,浅镇静达标率最高,右美托咪定次之。右美托咪定组和咪达唑仑组在给药后1 h、6 h的平均动脉压和心率均低于给药前(P<0.05);且在给药6 h时,瑞马唑仑组的平均动脉压和心率明显升高(P<0.05)。给药后24 h、72 h的白介素-1、白介素-6、皮质醇水平均高于给药前(P<0.05),但给药后72 h均低于给药后24 h。3组患者在给药后24 h、72 h的皮质醇水平比较,差异有统计学意义(P<0.05),且瑞马唑仑组均低于右美托咪定组和咪达唑仑组。3组患者在给药后72 h的白介素-1、白介素-6水平比较,差异有统计学意义(P<0.05),但瑞马唑仑组与右美托咪定组比较差异无统计学意义(P>0.05),且均低于咪达唑仑组(P<0.05)。3组患者呼吸抑制、心动过缓发生率比较差异均有统计学意义(P<0.05),但瑞马唑仑组心动过缓发生率最低,且呼吸抑制发生率仅次于右美托咪定组;瑞马唑仑组的低血压发生率最低,但三组患者比较差异无统计学意义(P>0.05)。结论与右美托咪定和咪达唑仑相比,瑞马唑仑对机械通气脓毒症患者具有浅镇静起效更快、达标率更高、稳定血流动力学效果更好、不良反应发生率更低的优势,但与右美托咪定的抗炎效果一致,均优于咪达唑仑。

Objective To investigate the application effect of remimazolam in patients with sepsis undergoing mechanical ventilation,and to analyze its sedative effect.Methods According to the random coin method,80 patients with sepsis who received mechanical ventila‐tion in our hospital from April 2021 to April 2023 were divided into remimazolam group(n=27),midazolam group(n=27)and dexme‐detomidine group(n=26).The sedative effects(Rass scale score,shallow sedation compliance time,and shallow sedation compliance rate)of the three groups were compared.The mean arterial pressure and heart rate of the three groups were recorded before administra‐tion,immediately after administration,1h after administration,and 6 h after administration.The changes of inflammatory stress response(interleukin-1,interleukin-6,cortisol)before administration,24 h and 72 h after administration were recorded,and the occurrence of ad‐verse reactions(hypotension,respiratory depression,bradycardia)was counted.Results There were statistically significant differences in Rass scale score,shallow sedation compliance time and shallow sedation compliance rate among the three groups(P<0.05),and the Richmond agitation and sedation scale score and shallow sedation compliance time in the remifentanil group were the lowest,and the shal‐low sedation compliance rate was the highest,followed by dexmedetomidine.The mean arterial pressure and heart rate of the dexmedeto‐midine group and the midazolam group at 1 h and 6 h after administration were lower than those before administration(P<0.05).At 6 h after administration,the mean arterial pressure and heart rate of the remifentanil group were higher than those of the dexmedetomidine group and lower than those of the midazolam group(P<0.05).The levels of interleukin-1,interleukin-6 and cortisol at 24 h and 72 h af‐ter administration were higher than those before administration(P<0.05),but the levels at 72 h after administration were lower than those at 24 h after administration.The cortisol levels of the three groups of patients at 24 h and 72 h after administration were statistically sig‐nificant(P<0.05),and the remimazolam group was lower than the dexmedetomidine group and the midazolam group.There were signifi‐cant differences in the levels of interleukin-1 and interleukin-6 among the three groups at 72 h after administration(P<0.05),However,there was no significant difference between remimazolam group and dexmedetomidine group(P>0.05),and both were lower than mid‐azolam group(P<0.05).There were statistically significant differences in the incidence of respiratory depression and bradycardia among the three groups(P<0.05),but the incidence of bradycardia in the remimazolam group was the lowest,and the incidence of respiratory de‐pression was second only to that in the dexmedetomidine group.The incidence of hypotension in remimazolam group was the lowest,but there was no statistical difference among the three groups(P>0.05).There was no significant difference in the incidence of hypotension(P>0.05).Conclusion Compared with dexmedetomidine and midazolam,remimazolam has the advantages of faster onset of shallow se‐dation,higher compliance rate,better hemodynamic stability and lower incidence of adverse reactions in patients with sepsis undergoing mechanical ventilation.However,it is consistent with the anti-inflammatory effect of dexmedetomidine and is superior to midazolam.