摘要
目的探究瑞马唑仑对老年肺部分切除术病人手术应激反应、术后苏醒质量及拔管时间影响。方法选择2020年10月—2023年12月在池州市人民医院择期行肺部分切除术的90例老年病人为研究对象,随机分为研究组和对照组,每组45例。研究组在术中麻醉诱导及麻醉维持均给予静脉注射瑞马唑仑,对照组则给予静脉注射丙泊酚,两组其他用药一致。比较两组病人不同观察时间血流动力学参数(心率(HR)、平均动脉压(MAP)、收缩压(SBP)和舒张压(DBP))、应激反应指标(血清皮质醇(Cor)、去甲肾上腺素(NE)、白细胞介素6(IL-6)和C反应蛋白(CRP))、术后苏醒质量(疼痛视觉模拟(VAS)评分和简易精神状态评价量表(MMSE)评分)、拔管时间和围术期不良反应等指标。结果重复测量方差分析表明,两组血流动力学参数和应激反应指标不同组别、不同时间及其交互效应比较,差异均有统计学意义(F_(组别)=4.147~370.949,F_(时间)=6.091~696.278,F_(交互)=3.789~118.453,P均<0.001);两组麻醉后不同时间HR、MAP和SBP均低于麻醉前(F=8.355~53.945,P均<0.05),研究组在麻醉诱导后5 min、单肺气管插管即刻及其插管后60 min的MAP显著高于对照组(F=2.822~4.641,P均<0.05);研究组Cor、NE、IL-6和CRP等在拔管后5 min和术后24 h均显著低于对照组(F=4.547~15.714,P均<0.05)。与对照组比较,研究组苏醒时间及拔管时间明显缩短,术后3 d的MMSE评分显著升高,而其MMSE评分手术前后差值明显降低,差异均有显著性(t=2.117~9.413,P<0.05)。两组病人术后6、12和24 h的VAS评分比较差异均无显著性(P>0.05),两组病人术后12和24 h的VAS评分均显著低于术后6 h(F=52.792、58.314,P<0.05)。研究组发生低血压、心动过缓、头晕、注射痛及恶心呕吐等不良反应构成比均显著低于对照组(χ^(2)=45.510~66.859,P<0.001)。结论与丙泊酚作为老年病人肺部分切除术麻醉诱导及维持用药效果比较,瑞马唑仑的血流动力学参数更稳定,术中应激反应较轻,术后苏醒质量较高,气管拔管时间较短,药物安全性更高。
Objective To investigate the effect of remimazolam on stress response,postoperative recovery quality,and extubation time in elderly patients undergoing partial pulmonary resection.Methods A total of 90 elderly patients who underwent elective partial pulmonary resection in Chizhou People’s Hospital from October 2020 to December 2023 were enrolled as subjects and were randomly divided into study group and control group,with 45 patients in each group.The patients in the study group were given intravenous injection of remimazolam during anesthesia induction and maintenance,while those in the control group were given intravenous injection of propofol,and the other medications remained the same between the two groups.The two groups were compared in terms of hemodynamic parameters(heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP),and diastolic blood pressure(DBP)),stress response indicators(serum cortisol(Cor),norepinephrine(NE),interleukin-6(IL-6),and C-reactive protein(CRP)),postoperative recovery quality(Visual Analogue Scale(VAS)pain score and Mini-Mental State Examination(MMSE)score),extubation time and perioperative adverse reactions at different time points.Results The repeated measures analysis of variance showed that there were significant differences in hemodynamic parameters and stress response indicators in comparisons based on group,time,and interaction(F_(group)=4.147-370.949,F_(time)=6.091-696.278,F_(interaction)=3.789-118.453,all P<0.001).Both groups had significant reductions in HR,MAP,and SBP at different time points after anesthesia(F=8.355-53.945,P<0.05),and compared with the control group,the study group had a significantly higher MAP at 5 minutes after anesthesia induction and immediately and at 60 minutes after one-lung tracheal intubation(F=2.822-4.641,P<0.05),as well as significantly lower levels of Cor,NE,IL-6,and CRP at 5 minutes after extubation and 24 hours after surgery(F=4.547-15.714,P<0.05).Compared with the control group,the study group had significantly shorter awakening time and extubation time,a significant increase in MMSE score on day 3 after surgery,and a significantly smaller difference in MMSE score before and after surgery(t=2.117-9.413,P<0.05).There was no significant difference in VAS score between the two groups at 6,12,and 24 hours after surgery(P>0.05),and for both groups,VAS score at 12 and 24 hours after surgery was significantly lower than that at 6 hours after surgery(F=52.792,58.314,P<0.05).Compared with the control group,the study group had significantly lower constituent ratios of patients with hypotension,bradycardia,dizziness,injection pain,nausea,and vomiting(χ^(2)=45.510-66.859,P<0.001).Conclusion Compared with propofol in anesthesia induction and maintenance for partial pulmonary resection in the elderly,remimazolam tends to have more stable hemodynamic parameters,milder intraoperative stress response,higher postoperative recovery quality,shorter tracheal extubation time,and a more favorable safety profile.
作者
徐智慧
黄俊
陈健
巩彦丰
包明胜
章荣庆
XU Zhihui;HUANG Jun;CHEN Jian;GONG Yanfeng;BAO Mingsheng;ZHANG Rongqing(Department of Anesthesiology,Chizhou People’s Hospital,Chizhou 247000,China)
出处
《青岛大学学报(医学版)》
2025年第2期255-260,共6页
Journal of Qingdao University(Medical Sciences)
基金
安徽省自然科学基金优青项目(2208085Y32)。
