瑞马唑仑与丙泊酚对老年眼底日间手术患者全麻恢复质量的影响

doi:10.3969/j.issn.1006-5725.2024.08.005

摘要/Abstract

摘要：

目的比较瑞马唑仑与丙泊酚对老年眼底日间手术患者全麻术后恢复质量的影响。方法选取择期接受喉罩全麻行眼底日间手术的老年患者110例，随机分成两组：瑞马唑仑组（R组）和丙泊酚组（P组）。R组予瑞马唑仑、舒芬太尼及罗库溴铵诱导，瑞马唑仑和瑞芬太尼麻醉维持。P组予丙泊酚、舒芬太尼及罗库溴铵诱导，丙泊酚和瑞芬太尼麻醉维持。以脑电双频指数（BIS）监测镇静水平。R组术毕予氟马西尼0.3 mg拮抗，P组等待自然苏醒。记录术前及术后3 d患者的恢复质量，采用恢复质量-15（the quality of recovery， QoR-15）量表评分；记录术中血流动力学数据，诱导期注射痛发生率，术中瑞芬太尼用量及液体入量；诱导期意识消失及术毕苏醒时间，喉罩拔除时间及入麻醉后监护病房（post anesthesia care unit， PACU）后不良事件的发生率等。结果 R组术后24 h的QoR-15评分与P组相当［（133.3 ± 11.1 vs. 135.0 ± 10.3）；平均差异（95%CI）1.7（-3.9，7.2）；非劣效性成立］。两组在术前及术后第2、3天QoR-15评分比较，差异无统计学意义（P > 0.05）。与P组比较，R组患者诱导期意识消失时间延长，术毕苏醒时间及喉罩拔除时间缩短（P < 0.05）。与P组比较，R组诱导期注射痛更少，患者的血流动力学更平稳（P < 0.05）。两组术中瑞芬太尼用量、液体总入量及在PACU不良反应发生情况差异无统计学意义（P > 0.05）。结论在老年眼底日间手术患者，应用瑞马唑仑麻醉诱导及维持，可达到与丙泊酚效果相同的术后恢复质量。与丙泊酚比较，瑞马唑仑可提供更稳定的血流动力学，患者苏醒及拔管更快，麻醉恢复效率更高。

关键词: 瑞马唑仑, 丙泊酚, 老年, 眼底手术, 日间手术

Abstract:

Objective To compare the effects of remimazolam vs propofol on the quality of recovery in elderly patients undergoing fundus daytime surgery after general anesthesia. Methods A total of 110 elderly patients undergoing day-time fundus surgery under laryngeal mask anesthesia were randomly divided into Remimazolam group and Propofol group. Patients in Remimazolam group were induced by remimazolam， sufentanil and rocuronium， and maintained by remimazolam and remifentanil. Patients in Propofol group were induced by propofol， sufentanil and rocuronium， and maintained by propofol and remifentanil. The level of sedation was monitored by bispectral index. After surgery， patients were antagonized by flumazenil in Remimazolam group but not in propfolgroup. The quality of patients' recovery was recorded before operation and three days after operation measured by quality of recovery-15 （QoR-15） scale. Intraoperative hemodynamic data，the time to consciousness loss during induction and awakening after operation，the time for laryngeal mask removal and the incidence of adverse events after admission to post anesthesia care unit were also recorded. Results The QoR-15 score in Remimazolam group 24 hours after operation was non-inferior to that in propofol group （133.3 ±11.1 vs. 135.0±10.3； mean difference （95% CI）1.7 （-3.9， 7.2）； approving for non- inferiority）. There was no significant difference in QoR-15 scores between the two groups before operation or any other setting points. Compared with Propofol group， the time to consciousness loss during induction was prolonged， and the time for awakening after operation and laryngeal mask removal were shortened in Remimazolam group（all P < 0.05）. Compared with Propofol group， the hemodynamics of patients in Remimazolam group was more stable （P < 0.05）. There was no significant difference in the total dosage of remifentanil， fluid， or in the incidence of adverse reactions in PACU between the two groups （P > 0.05）. Conclusion In elderly patients undergoing day-time fundus surgery， induction and maintenance of anesthesia with Remimazolam could achieve the similar quality of postoperative recovery with propofol. Compared with propofol， remimazolam provide more stable hemodynamics and shorter recovery time and extubated time， contributing to higher efficiency in recovery period.

Key words: remimazolam, propofol, elder, fundus, day surgery

中图分类号:

R614

陈红芽,王惠军,王月,苏少飞,王古岩. 瑞马唑仑与丙泊酚对老年眼底日间手术患者全麻恢复质量的影响[J]. 实用医学杂志, 2024, 40(8): 1052-1057.

Hongya CHEN,Huijun WANG,Yue WANG,Shaofei SU,Guyan. WANG. Remimazolam versus propofol on quality of recovery after general anesthesia in elders undergoing ocular fundus daytime surgery[J]. The Journal of Practical Medicine, 2024, 40(8): 1052-1057.

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参考文献 25

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项目	P组（n = 55）	R组（n = 55）	χ2/t值	P值
年龄（岁）	71.5 ± 5.8	72.3 ± 5.5	-0.173	0.867
BMI（kg/m²）	24.3 ± 2.5	24.6 ± 2.1	-0.190	0.854
性别（例）			0.146	0.703
男	28	26
女	27	29
ASA分级［例（%）］			-0.201	0.654
Ⅰ级	12（22）	14（25）
Ⅱ级	43（78）	41（75）

项目	P组（n = 55）	R组（n = 55）	平均差值（95% CI）	P 值
QoR-15评分
术前	146.2 ± 9.9	144.5 ± 9.5	1.7（-1.7 ~ 5.0）	0.295
术后24 h	135.0 ± 10.3	133.3 ± 11.1	1.7（-3.9 ~ 7.2）	0.518
术后48 h	136.1 ± 8.9	134.8 ± 8.2	1.3（-2.5 ~ 5.1）	0.453
术后72 h	138.5 ± 4.2	138.5 ± 4.2	0.0（-3.0 ~ 3.0）	1.000
生理舒适度
术前	47.2 ± 5.2	45.7 ± 5.4	1.5（-0.9 ~ 3.9）	0.202
术后24 h	41.8 ± 5.7	40.2 ± 6.9	1.7（-1.4 ~ 4.8）	0.257
术后48 h	42.9 ± 4.9	40.7 ± 5.1	2.2（-0.1 ~ 4.4）	0.056
术后72 h	43.9 ± 2.0	42.9 ± 1.9	1.0（-1.6 ~ 3.6）	0.405
生理独立性
术前	19.5 ± 4.8	19.3 ± 4.2	0.2（-1.2 ~ 1.5）	0.787
术后24 h	14.2 ± 4.2	14.5 ± 3.9	-0.3（-3.0 ~ 2.4）	0.790
术后48 h	14.3 ± 2.2	15.2 ± 1.7	-0.8（-3.3 ~ 1.7）	0.477
术后72 h	14.7 ± 1.9	15.7 ± 1.7	-1.0（-3.3 ~ 1.3）	0.346
心理支持
术前	20.0 ± 0.0	20.0 ± 0.0	0.0（-1.1 ~ 1.1）	1.000
术后24 h	19.5 ± 0.8	19.5 ± 0.8	0.0（-1.1 ~ 1.1）	1.000
术后48 h	19.5 ± 0.8	19.5 ± 0.8	0.0（-1.1 ~ 1.1）	1.000
术后72 h	20.0 ± 0.0	20.0 ± 0.0	0.0（-1.1 ~ 1.1）	1.000
情感
术前	39.7 ± 0.5	39.7 ± 0.5	0.0（-0.7 ~ 0.7）	1.000
术后24 h	39.7 ± 0.8	39.6 ± 0.8	0.2（-0.9 ~ 1.2）	0.734
术后48 h	39.6 ± 0.8	39.6 ± 0.8	0.0（-1.1 ~ 1.1）	1.000
术后72 h	39.9 ± 0.4	39.9 ± 0.4	0.0（-0.5 ~ 0.5）	1.000
疼痛
术前	19.8 ± 0.4	19.8 ± 0.4	0.0（-0.5 ~ 0.5）	1.000
术后24 h	19.8 ± 0.4	19.7 ± 0.5	0.2（-0.4 ~ 0.7）	0.549
术后48 h	19.8 ± 0.4	20.0 ± 0.0	-0.2（-0.5 ~ 0.2）	0.341
术后72 h	20.0 ± 0.0	19.8 ± 0.4	0.2（-0.2 ~ 0.5）	0.341

组别	例数	意识消失时间（s）	苏醒时间（min）	喉罩拔除时间（min）
P组	50	41.9 ± 3.1	10.2 ± 2.2	11.1 ± 2.1
R组	50	66.9 ± 3.2	7.5 ± 2.0	8.5 ± 2.2
t值		-4.881	2.299	2.263
P 值		0.000	0.040	0.043

指标	组别	T₀	T₁	T₂	T₃	T₄	T₅	T₆
MAP（mmHg）	P组	113.5 ± 8.7	82.0 ± 13.4	76.5 ± 12.0	69.7 ± 11.3	100.2 ± 9.8	95.8 ± 5.9	95.8 ± 6.4
	R组	98.3 ± 4.1	92.0 ± 22.0	90.3 ± 13.5	89.3 ± 11.9	106.0 ± 5.4	100.3 ± 13.5	87.3 ± 14.4
	t值	0.884	-0.953	-1.875	-2.938	-1.278	-0.746	1.321
	P值	0.397	0.363	0.090	0.015	0.230	0.473	0.216
HR（次/min）	P组	65.3 ± 10.2	73.8 ± 3.1	60.8 ± 8.0	59.0 ± 6.3	59.0 ± 7.9	61.0 ± 9.9	64.0 ± 9.3
	R组	68.7 ± 14.5	69.2 ± 13.2	64.0 ± 7.5	63.3 ± 9.0	66.2 ± 10.2	72.2 ± 22.6	64.4 ± 9.8
	t值	-0.460	0.842	-0.708	-0.963	-1.362	-1.107	-0.069
	P 值	0.655	0.420	0.495	0.358	0.203	0.294	0.946
BIS	P组	92.7 ± 7.9	65.0 ± 23.5	38.8 ± 11.8	51.8 ± 6.3	87.5 ± 3.8
	R组	96.2 ± 1.2	74.0 ± 7.2	59.0 ± 3.7	62.3 ± 3.0	82.2 ± 4.5
	t值	-1.071	-0.897	-4.010	-3.680	2.200
	P 值	0.309	0.391	0.002	0.004	0.052

项目	P组（n = 55）	R组（n = 55）	t值	P 值
瑞芬用量（μg）	796.8 ± 238.5	681.6 ± 292.8	0.785	0.455
液体入量（mL）	720.0 ± 189.0	670.0 ± 210.9	0.395	0.703
手术时长（min）	98.3 ± 21.4	96.5 ± 25.9	0.118	0.909
麻醉时长（min）	110.3 ± 25.3	112.3 ± 23.1	-0.128	0.902