摘要
目的观察不同剂量瑞马唑仑用于老年冠心病患者非心脏手术全身麻醉诱导的效果。方法选取2023年10月~2024年10月于郑州大学附属洛阳中心医院择期接受气管插管下全身麻醉的老年冠心病非心脏手术患者120例,年龄60~85岁,按照随机数字表法将其分为3组:R_(1)组、R_(2)和R_(3)组,每组各40例,单次推注瑞马唑仑剂量分别为0.2、0.25、0.3mg/kg。对比3组患者诱导前(T_(1))、改良警觉/镇静(modified observers assessment of alertness/sedation,MOAA/S)评分0分时(T_(2))、插管后15s(T_(3))不同时点平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、心排出量(cardiac output,CO)、每搏变异度(stroke volume variation,SVV)、系统血管阻力(systemic vascular resistance,SVR)、局部脑氧饱和度(regional cerebral oxygen saturation,rScO_(2))以及记录意识消失时间、血管活性药物使用情况、呃逆和低氧血症发生率等。结果与T_(1)时点比较,3组患者T_(2)时点MAP、SVR均降低,R_(2)组、R_(3)组均明显低于R_(1)组(P<0.05);在T_(3)时点,R_(1)组MAP、HR均明显高于R_(2)组、R_(3)组,且R_(1)组内比较T_(3)时点高于T_(1)时点(P<0.05);3组患者CO、SVV及rScO_(2)不同时点比较,差异均无统计学意义(P>0.05)。意识消失时间随瑞马唑仑诱导剂量增加而缩短,R_(1)组与R_(2)组诱导期间艾司洛尔应用比例明显多于R_(3)组(P<0.05)。3组不良事件发生率差异无统计学意义(P>0.05)。结论瑞马唑仑应用于老年冠心病患者的全身麻醉诱导是安全、有效的,其中0.3mg/kg麻醉诱导效果更佳。
Objective To observe the effects of different doses remimazolam during induction of anesthesia in elderly patients with coronary heart disease undergoing non-cardiac surgery.Methods A total of 120 elderly patients with non-cardiac surgery for coronary heart disease and received general anesthesia under tracheal intubation at Luoyang Central Hospital Affiliated to Zhengzhou University from October 2023 to October 2024,aged 60-85 years.The patients were divided into 3groups by random number table:group R_(1),group R_(2)and group R_(3),with 40 cases in each group,with anesthesia was induced with intravenous injection of remimazolam of 0.2,0.25,0.3mg/kg,respectively.Before induction(T_(1)),modified observers assessment of alertness/sedation(MOAA/S)score reached to 0 points(T_(2)),15seconds after intubation(T_(3)),mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),stroke volume variation(SVV),systemic vascular resistance(SVR),and regional cerebral oxygen saturation(rScO_(2))were compared among the three groups,as well as the time to loss of consciousness,use of vasoactive drugs,and the incidence of hiccups and hypoxemia were recorded.Results Compared with the T_(1),MAP and SVR decreased significantly in all groups at T_(2),with group R_(2)and R_(3)showing lower values than group R_(1)(P<0.05);at T_(3),the MAP and HR in group R_(1)was higher than group R_(2)and group R_(3)compared with T_(1),the MAP and HR in group R_(1)were significantly increased at T_(3)(P<0.05).There was no significant difference in CO,SVV and rScO_(2)among three groups at different time(P>0.05).The time of loss of consciousness reduced with the increase of the dose of remimazolam.The application proportion of esmololhydrochloride in group R_(1)and group R_(2)was more than group R_(3)during induction of general anesthesia(P<0.05).There was no significant difference in incidence of adverse events among three groups(P>0.05).Conclusion Remimazolam can be used safely and effectively for the induction of general anesthesia in elderly patients with coronary heart disease undergoing non-cardiac surgery,and doses of 0.3mg/kg is more effective for anesthesia induction.
作者
周彪
崔鹏
胡杰
孙佳
刘雅君
ZHOU Biao;CUI Peng;HU Jie(Department of Anethesiology,Luoyang Central Hospital Affiliated to Zhengzhou University,Henan 471003,China)
出处
《医学研究杂志》
2025年第8期129-133,67,共6页
Journal of Medical Research
基金
河南省医学科技攻关项目(232102310221)。
关键词
瑞马唑仑
老年人
冠心病
全身麻醉诱导
Remimazolam
Elderly patients
Coronary heart disease
Induction of anesthesia
