摘要
目的:评价瑞马唑仑在全凭静脉麻醉(total intravenous anesthesia,TIVA)下行甲状腺癌根治术的麻醉效果。方法:选取拟在TIVA下行择期甲状腺癌根治手术患者,年龄18~65岁;ASA分级:Ⅰ~Ⅱ级。本研究分为2部分:第1部分应用改良序贯法探究瑞马唑仑的麻醉诱导剂量,第2部分评价瑞玛唑仑在TIVA中的麻醉维持效果。研究对象随机分为两组:对照组丙泊酚组(P组)和试验组瑞马唑仑组(R组)。麻醉诱导气管插管后,继之以丙泊酚或瑞马唑仑在TIVA下完成手术。比较两组起效时间、气管插管时间、药物总用量及术中关键时点的血流动力学指标差异。同时评估两组患者术后苏醒时间及不良反应;应用MMSE及MoCA量表评估认知功能变化等。结果:序贯法研究发现丙泊酚的诱导剂量为1.76 mg·kg^(-1),相应的瑞马唑仑诱导剂量为0.43 mg·kg^(-1)。两组起效时间无明显差异(P>0.05);R组气管插管时间为(103.23±9.14)s,比P组(86.58±8.32)s略延长(P<0.05)。在TIVA中,瑞马唑仑平均泵速为1.12 mg·kg^(-1)·h^(-1)。与P组相比,R组在目标麻醉深度下血流动力学更加平稳[P<0.05,P组MAP为(77.9±7.4)mmHg,R组MAP为(88.2±8.4)mmHg;P组HR为(68.8±6.5)次·min^(-1),R组HR为(74.2±7.1)次·min^(-1)]。R组患者术后苏醒时间为(19.31±4.26)min比P组(13.86±3.65)min略延长(P<0.05)。两组术后不良反应及认知功能比较无明显统计学差异(P>0.05)。结论:瑞马唑仑可安全应用于TIVA诱导及麻醉维持行甲状腺癌根治术,其在TIVA应用中血流动力学更趋于平稳。
Objective:To evaluate the anesthetic effects of remimazolam in total intravenous anesthesia(TIVA)patients undergoing radical thyroidectomy.Methods:Patients aged 18^65 with ASA physical status Ⅰ^Ⅱwere scheduled for radical thyroidectomy under TIVA.The current study consisted of two parts.Part Ⅰ:The anesthetic induction dose of remimazolam was determined using modified Dixon's up-and-down method.Part Ⅱ:The effect of remimazolam in anesthetic maintenance of TIVA was evaluated.The patients were randomly divided into two groups,propofol as control P group and remimazolam as experimental R group.After endotracheal intubation,propofol or remimazolam was continuously infused under TIVA to complete surgery.The onset time,intubation time,drug consumption and hemodynamics at certain time points were analyzed.In addition,the awakening time and adverse effects were also compared.The cognitive functions were evaluated by scale of MMSE and MoCA.Results:The anesthetic induction doses of propofol and remimazolam were 1.76 mg·kg^(-1)and 0.43 mg·kg^(-1)respectively.The onset time of the two groups had no significant difference(P>0.05).However,the intubation time of remimazolam group(103.23±9.14)s was significantly increased than that of the control group(86.58±8.32)s(P<0.05).The mean pump speed of remimazolam was 1.12 mg·kg^(-1)·h^(-1)in TIVA.The hemodynamics of remimazolam group[MAP:(88.2±8.4)mmHg;HR:(74.2±7.1)per minute]was more stable than that of the control group[MAP:(77.9±7.4)mmHg;HR:(68.8±6.5)per minute](P<0.05).The awakening time of remimazolam group(19.31±4.26)min was enhanced compared with the control group(13.86±3.65)min(P<0.05).The adverse effects and cognitive functions of the two groups had no statistical differences(P>0.05).Conclusion:Remimazolam is safe for clinical anesthetic induction and intraoperative maintenance undergoing radical thyroidectomy,and the hemodynamics is more stable in TIVA.
作者
伊万青
胡淇云
钱少杰
刘金涛
毛慧
蔡放
王文元
YI Wan-qing;HU Qi-yun;QIAN Shao-jie;LIU Jin-tao;MAO Hui;CAI Fang;WANG Wen-yuan(Zhejiang Chinese Medical University,Hangzhou 310053,China;Zhejiang Provincial People's Hospital,Affiliated People's Hospital,Hangzhou Medical College,Hangzhou 310014,China)
出处
《中国新药杂志》
CAS
CSCD
北大核心
2023年第12期1237-1242,共6页
Chinese Journal of New Drugs
基金
浙江省医药卫生科研项目(2023KY048)。
关键词
苯二氮[艹卓]类
全凭静脉麻醉
镇静
认知功能
benzodiazepines
total intravenous anesthesia
sedation
cognitive function
