摘要
目的探讨瑞马唑仑与咪达唑仑对腹腔镜手术焦虑患者认知功能及胃肠道功能影响。方法选取2021年12月至2022年12月丹东市第一医院行腹腔镜手术患者共96例,按随机数字表法分成咪达唑仑组、瑞马唑仑组和对照组,每组32例。瑞马唑仑组麻醉诱导前静脉注射瑞马唑仑进行术前镇静、咪达唑仑组麻醉诱导前静脉注射瑞咪达唑仑进行术前镇静和对照组麻醉诱导前静脉滴注生理盐水以作对照。收集所有患者的一般资料,麻醉效果、术后胃肠道功能及不良事件发生率,并进行统计分析。结果瑞马唑仑组睁眼时间、拔管时间、麻醉监测治疗室(PACU)停留时间[分别为(11.27±1.93)min、(12.64±2.17)min、(24.08±4.61)min],低于咪达唑仑组[分别为(13.44±2.37)min、(14.75±2.53)min、(27.95±5.33)min](均P<0.05),瑞马唑仑组、咪达唑仑组均低于对照组[分别为(10.35±1.92)min、(11.23±1.90)min、(21.72±3.18)min](均P<0.05);瑞马唑仑组术毕即刻、术后24 h S100β蛋白浓度[分别为(573.73±86.97)pg·mL^(-1)、(541.69±87.74)pg·mL^(-1)],低于咪达唑仑组[分别为(944.55±91.47)pg·mL^(-1)、(608.32±85.20)pg·mL^(-1)](均P<0.05),瑞马唑仑组、咪达唑仑组均低于对照组[分别为(1161.36±101.32)pg·mL^(-1)、(731.35±76.14)pg·mL^(-1)](均P<0.05);瑞马唑仑组术毕即刻、术后24 h的简易精神状态量表(MMSE)评分[分别为(25.41±2.10)分、(26.56±2.33)分],高于咪达唑仑组[分别为(24.23±2.14)分、(25.37±2.02)分](均P<0.05),瑞马唑仑组、咪达唑仑组均高于对照组[分别为(23.15±2.12)分、(24.21±2.18)分(均P<0.05)];瑞马唑仑组和咪达唑仑组术后首次肛门排气时间、首次排便时间、术后住院时间均短于对照组(均P<0.05);瑞马唑仑组和咪达唑仑组的进食-恶心-呕吐-查体-症状持续时间评分系统(I-FEED)评分分别为(0.34±0.01)分、(0.33±0.01)分,低于对照组的(1.03±0.24)分(均P<0.05);瑞马唑仑组和咪达唑仑组术后当日睡眠质量评分分别为(7.34±1.25)分和(7.29±1.32)分,高于对照组的(6.41±0.98)分(均P<0.05);3组术后30 min Ramsay镇静评分、不良事件发生率,组间对比差异均无统计学意义(均P>0.05)。结论麻醉诱导前使用咪达唑仑和瑞马唑仑能缓解患者围手术期焦虑,有利于患者腹腔镜手术后胃肠道功能的恢复,且瑞马唑仑较咪达唑仑疗效更佳,但两者对于术后认知功能都有一定影响。
Objective To explore the effects of remimazolam and midazolam on cognitive and gastrointestinal function in patients with anxiety after laparoscopic surgery.Methods A total of 96 patients receiving laparoscopic surgery in Dandong First Hospital from December 2021 to December 2022 were divided into a midazolam group,a remimazolam group and a control group using the random number table method,with 32 in each group.The patients in the remimazolam group received intravenous injection of remimazolam,those in the midazolam group received intravenous injection of midazolam,and those in the control group received intravenous injection of physiological saline for preoperative sedation before anesthesia induction.General information of all patients including anesthesia efficacy,postoperative gastrointestinal function,and incidence of adverse events were determined and compared among the three groups.Results The eye opening time,extubation time,and PACU stay time in the remimazolam group were(11.27±1.93)min,(12.64±2.17)min,and(24.08±4.61)min,respectively,lower than those in the midazolam group((13.44±2.37)min,(14.75±2.53)min,and(27.95±5.33)min,respectively)(P<0.05).These indexes were lower in both the remimazolam group and the midazolam group than in the control((10.35±1.92)min,(11.23±1.90)min,and(21.72±3.18)min,respectively)(P<0.05).The concentration of S100βprotein in the remimazolam group immediately after surgery and 24 hours after surgery was(573.73±86.97)pg·mL^(-1),(541.69±87.74)pg·mL^(-1),respectively,which was lower than that in the midazolam group((944.55±91.47)pg·mL^(-1),(608.32±85.20)pg·mL^(-1),respectively)(P<0.05).They were lower in both the remimazolam group and the midazolam group than in the control((1161.36±101.32)pg·mL^(-1),(731.35±76.14)pg·mL^(-1),respectively)(P<0.05).The mini mental state examination(MMSE)scores of the remimazolam group immediately after surgery and 24 hours after surgery were(25.41±2.10)points and(26.56±2.33)points,respectively,higher than those of the midazolam group((24.23±2.14)points and(25.37±2.02)points,respectively)(P<0.05),and they were higher in both the remimazolam group and the midazolam group than in the control((23.15±2.12)points and(24.21±2.18)points,respectively)(P<0.05).The postoperative first anal exhaust time,first defecation time,and postoperative hospital stay in the remimazolam group and midazolam group were all lower than those in the control group(P<0.05).The I-FEED scores of the remimazolam group and midazolam group were(0.34±0.01)points and(0.33±0.01)points,respectively,both lower than the control group’s(1.03±0.24)points(P<0.05).The sleep quality scores of the remimazolam group and midazolam group on the day after surgery were(7.34±1.25)points and(7.29±1.32)points,respectively,both higher than the control group’s(6.41±0.98)points(P<0.05).There was no statistically significant difference in Ramsay score and incidence of adverse events among the three groups 30 minutes after surgery(P>0.05).Conclusion Preoperative use of midazolam and remimazolam before anesthesia induction can alleviate preoperative anxiety and promote postoperative gastrointestinal recovery in patients undergoing laparoscopic surgery.Remimazolam shows greater efficacy than midazolam.However,both drugs have a certain impact on postoperative cognitive function.
作者
李卫东
李娟
原忠伟
Li Wei-dong;Li Juan;Yuan Zhong-wei(Department of Anesthesiology,Dandong First Hospital,Dandong 118000,China)
出处
《中国药物应用与监测》
CAS
2024年第6期774-778,共5页
Chinese Journal of Drug Application and Monitoring
关键词
瑞马唑仑
咪达唑仑
腹腔镜手术
认知功能
胃肠道功能
Remimazolam
Midazolam
Laparoscopic surgery
Cognitive function
Gastrointestinal function
