摘要
目的探讨不同剂量瑞马唑仑对全身麻醉患者术后嗜睡及谵妄等不良反应发生的影响。方法选择2022年1月至2022年7月于新乡医学院第一附属医院行四肢手术的患者450例为研究对象,按照随机数字表法将患者分为对照组、低剂量瑞马唑仑组和高剂量瑞马唑仑组,每组150例。3组患者均静脉注射丙泊酚、舒芬太尼、罗库溴铵进行麻醉诱导。麻醉维持:对照组患者静脉泵注丙泊酚4 mg·kg^(-1)·h^(-1),0.6~1.0肺泡最低有效浓度(MAC)七氟烷吸入,持续泵注瑞芬太尼0.2μg·kg^(-1)·min^(-1);低剂量瑞马唑仑组患者静脉泵注甲苯磺酸瑞马唑仑0.5 mg·kg^(-1)·h^(-1),0.6~1.0 MAC七氟烷吸入,持续泵注瑞芬太尼0.2μg·kg^(-1)·min^(-1);高剂量瑞马唑仑组患者静脉泵注甲苯磺酸瑞马唑仑1.0 mg·kg^(-1)·h^(-1),0.6~1.0 MAC七氟烷吸入,持续泵注瑞芬太尼0.2μg·kg^(-1)·min^(-1);术中维持脑电双频指数在40~60。结果低剂量瑞马唑仑组患者意识恢复时间及喉罩拔除时间显著短于对照组(P<0.05),高剂量瑞马唑仑组患者意识恢复时间及喉罩拔除时间显著长于对照组和低剂量瑞马唑仑组(P<0.05)。高剂量瑞马唑仑组患者使用氟马西尼拮抗的比例显著高于低剂量瑞马唑仑组(P<0.05)。高剂量瑞马唑仑组患者麻醉恢复期间嗜睡发生率显著高于对照组和低剂量瑞马唑仑组(P<0.05);低剂量瑞马唑仑组与对照组患者麻醉恢复期间嗜睡发生率比较差异无统计学意义(P>0.05)。低剂量瑞马唑仑组和高剂量瑞马唑仑组患者在麻醉恢复期间谵妄发生率显著低于对照组(P<0.05);高剂量瑞马唑仑组患者在麻醉恢复期间谵妄发生率显著高于低剂量瑞马唑仑组(P<0.05)。3组患者回病房后24 h内嗜睡发生率比较差异无统计学意义(P>0.05)。结论行四肢手术患者全身麻醉时使用低剂量瑞马唑仑(0.5 mg·kg^(-1)·h^(-1))不仅可维持良好的麻醉效果,还可缩短患者意识恢复时间和喉罩拔除时间,且在减少术后谵妄的同时未显著增加嗜睡发生率,具有较好的安全性和可控性;而高剂量瑞马唑仑(1.0 mg·kg^(-1)·h^(-1))虽同样可降低谵妄的发生率,但其延迟苏醒、嗜睡发生率增加及对拮抗剂依赖性较高,需谨慎使用。低剂量瑞马唑仑在保障麻醉深度的同时,有助于优化患者的术后恢复质量,临床应用价值更高。
Objective To investigate the effects of different doses of remimazolam on the incidence of postoperative somnolence,delirium,and other adverse reactions in patients undergoing general anesthesia.Methods A total of 450 patients who underwent limb surgery at the First Affiliated Hospital of Xinxiang Medical University from January 2022 to July 2022 were selected as research subjects,the patients were divided into control group,low-dose remimazolam group,and high-dose remimazolam group by using a randomized number table.All patients received intravenous induction with propofol,sufentanil,and rocuronium bromide.For anesthesia maintenance:the patients in the control group received intravenous infusion of propofol(4 mg·kg^(-1)·h^(-1)),inhalation of sevoflurane[0.6^(-1).0 minimum alveolar concentration(MAC)],and continuous infusion of remifentanil(0.2μg·kg^(-1)·min^(-1));the patients in the low-dose remimazolam group received intravenous infusion of remimazolam toluenesulfonate(0.5 mg·kg^(-1)·h^(-1)),inhalation of sevoflurane(0.6^(-1).0 MAC),and continuous infusion of remifentanil(0.2μg·kg^(-1)·min^(-1));the patients in the high-dose remimazolam group received intravenous infusion of remimazolam toluenesulfonate(1.0 mg·kg^(-1)·h^(-1)),inhalation of sevoflurane(0.6^(-1).0 MAC),and continuous infusion of remifentanil(0.2μg·kg^(-1)·min^(-1)).Intraoperative electroencephalogram bispectral index was maintained between 40 and 60 in all groups.Results The recovery time of consciousness and the time to laryngeal mask removal were significantly shorter in the low-dose remimazolam group compared to the control group(P<0.05).In contrast,the recovery time of consciousness and the time to laryngeal mask removal in the high-dose remimazolam group were significantly longer than those in the control group and low-dose remimazolam group(P<0.05).The proportion of patients requiring flumazenil antagonism was significantly higher in the high-dose remimazolam group compared to the low-dose remimazolam group(P<0.05).The incidence of emergence somnolence from anesthesia in the high-dose remimazolam group was significantly higher than that in the control group and low-dose remimazolam group(P<0.05).However,there was no statistically significant difference in somnolence incidence between the low-dose remimazolam group and the control group(P>0.05).The incidence of emergence delirium in both the low-dose and high-dose remimazolam groups was significantly lower than that in the control group(P<0.05).Nonetheless,the incidence of delirium in the high-dose remimazolam group was significantly higher than that in the low-dose remimazolam group(P<0.05).No statistically significant differences were observed among the three groups in the incidence of somnolence within 24 hours after returning to the ward(P>0.05).Conclusion Low-dose remimazolam(0.5 mg·kg^(-1)·h^(-1))not only provides effective anesthesia maintenance but also shortens the time to recovery of consciousness and laryngeal mask removal.Additionally,it does not significantly increase the incidence of postoperative somnolence while effectively reducing the occurrence of delirium,indicating a favorable safety and controllability profile.Conversely,high-dose remimazolam(1.0 mg·kg^(-1)·h^(-1)),while also capable of decreasing the incidence of delirium,is associated with delayed awakening,a higher incidence of somnolence,and an increased need for flumazenil antagonism,thus warranting cautious use.Low-dose of remimazolam appears to optimize the quality of postoperative recovery while ensuring adequate anesthetic depth,making it a valuable option in clinical practice.
作者
刘旭
赵志莉
沈丹
赵际平
和谦
王嘉慧
刘俊
LIU Xu;ZHAO Zhili;SHEN Dan;ZHAO Jiping;HE Qian;WANG Jiahui;LIU Jun(Department of Anesthesia,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
2025年第8期664-668,共5页
Journal of Xinxiang Medical University
关键词
瑞马唑仑
全身麻醉
术后谵妄
嗜睡
脑电双频指数
remimazolam
general anesthesia
postoperative delirium
somnolence
electroencephalogram bispectral index
