收稿日期: 2023-07-26
网络出版日期: 2024-04-19
基金资助
北京市医院管理中心临床医学发展专项“扬帆”计划项目(ZYLX202103);北京市医院管理中心“登峰”计划项目(DFL20220203)
Remimazolam versus propofol on quality of recovery after general anesthesia in elders undergoing ocular fundus daytime surgery
Received date: 2023-07-26
Online published: 2024-04-19
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。
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 . DOI: 10.3969/j.issn.1006-5725.2024.08.005
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
| 1 | DOI M， MORITA K， TAKEDA J， et al. Efficacy and safety of remimazolam versus propofol for general anesthesia： a multicenter， single-blind， randomized， parallel-group， phase IIb/III trial［J］. J Anesth， 2020，34（4）：543-553. doi:10.1007/s00540-020-02788-6 |
| 2 | ZHANG X， LI S， LIU J. Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy： single-centre randomized controlled trial［J］. BMC Anesthesiol， 2021，21（1）：156. doi:10.1186/s12871-021-01373-y |
| 3 | CHEN S H， YUAN T M， ZHANG J， et al. Remimazolamtosilate in upper gastrointestinal endoscopy： A multicenter， randomized， non-inferiority， phase Ⅲ trial［J］. J Gastroenterol Hepatol， 2021，36（2）：474-481. doi:10.1111/jgh.15188 |
| 4 | SONG S W， JANG Y N， YOON M W， et al. Quality of recovery in patients administered remimazolam versus those administered an inhalant agent for the maintenance of general anesthesia： a randomized control trial［J］. BMC Anesthesiol， 2022，22（1）：226. doi:10.1186/s12871-022-01770-x |
| 5 | WESSELS E， PERRIE H， SCRIBANTE J， et al. Quality of recovery in the perioperative setting： A narrative review［J］. J Clin Anesth， 2022，78：110685. doi:10.1016/j.jclinane.2022.110685 |
| 6 | BU X S， ZHANG J， ZUO Y X. Validation of the Chinese Version of the Quality of Recovery-15 Score and Its Comparison with the Post-Operative Quality Recovery Scale［J］. Patient， 2016，9（3）：251-259. doi:10.1007/s40271-015-0148-6 |
| 7 | JAENSSON M， NILSSON U， DAHLBERG K. Methods and timing in the assessment of postoperative recovery： a scoping review［J］. Br J Anaesth， 2022，129（1）：92-103. doi:10.1016/j.bja.2022.04.015 |
| 8 | QIU Q， CHOI S W， WONG S S， et al. Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis［J］. Anaesthesia， 2016，71（10）：1222-1233. doi:10.1111/anae.13578 |
| 9 | CHEN Y， JIANG S， WU Y. Effect of 2 different anesthesia methods on stress response in neurosurgical patients with hypertension or normal： A prospective clinical trial［J］. Medicine （Baltimore）， 2016，95（35）：e4769. doi:10.1097/md.0000000000004769 |
| 10 | SHIN S W， CHO A R， LEE H J， et al. Maintenance anaesthetics during remifentanil-based anaesthesia might affect postoperative pain control after breast cancer surgery［J］. Br J Anaesth， 2010，105（5）：661-667. doi:10.1093/bja/aeq257 |
| 11 | 王静，高煜茹，蔡钱伟，等. 瑞马唑仑通过调节肺泡巨噬细胞极化减轻脂多糖诱导的急性肺损伤［J］. 实用医学杂志，2023，39（9）：1092-1097. doi:10.3969/j.issn.1006-5725.2023.09.005 |
| 12 | LIU X， LIN S， ZHONG Y， et al. Remimazolam Protects Against LPS-Induced Endotoxicity Improving Survival of Endotoxemia Mice［J］. Front Pharmacol， 2021，12：739603. doi:10.3389/fphar.2021.739603 |
| 13 | SHI M， CHEN J， LIU T， et al. Protective Effects of Remimazolam on Cerebral Ischemia/Reperfusion Injury in Rats by Inhibiting of NLRP3 Inflammasome-Dependent Pyroptosis［J］. Drug Des Devel Ther， 2022，16：413-423. doi:10.2147/dddt.s344240 |
| 14 | FANG H， ZHANG Y， WANG J， et al. Remimazolam reduces sepsis-associated acute liver injury by activation of peripheral benzodiazepine receptors and p38 inhibition of macrophages［J］. Int Immunopharmacol， 2021，101（Pt B）：108331. doi:10.1016/j.intimp.2021.108331 |
| 15 | BEVANS T， DEERING-RICE C， STOCKMANN C， et al. Inhaled Remimazolam Potentiates Inhaled Remifentanil in Rodents［J］. Anesth Analg， 2017，124（5）：1484-1490. doi:10.1213/ane.0000000000002022 |
| 16 | XIE H， LU F， LIU W， et al. Remimazolam alleviates neuropathic pain via regulating bradykinin receptor B1 and autophagy［J］. J Pharm Pharmacol， 2021，73（12）：1643-1651. doi:10.1093/jpp/rgab080 |
| 17 | HARI Y， SATOMI S， MURAKAMI C， et al. Remimazolam decreased the incidence of early postoperative nausea and vomiting compared to desflurane after laparoscopic gynecological surgery［J］. J Anesth， 2022，36（2）：265-269. doi:10.1007/s00540-022-03041-y |
| 18 | CHOI J Y， LEE H S， KIM J Y， et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery： A randomized non-inferiority trial［J］. J Clin Anesth， 2022，82：110955. doi:10.1016/j.jclinane.2022.110955 |
| 19 | MAO Y， GUO J， YUAN J， et al. Quality of Recovery After General Anesthesia with Remimazolam in Patients' Undergoing Urologic Surgery： A Randomized Controlled Trial Comparing Remimazolam with Propofol［J］. Drug Des Devel Ther， 2022，16：1199-1209. doi:10.2147/dddt.s359496 |
| 20 | BUCHANAN F F， MYLES P S， CICUTTINI F. Effect of patient sex on general anaesthesia and recovery［J］. Br J Anaesth， 2011，106（6）：832-839. doi:10.1093/bja/aer094 |
| 21 | STARK P A， MYLES P S， BURKE J A. Development and psychometric evaluation of a postoperative quality of recovery score： the QoR-15［J］. Anesthesiology， 2013，118（6）：1332-1340. doi:10.1097/aln.0b013e318289b84b |
| 22 | YANG J J， LEI L， QIU D， et al. Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery： A Prospective Randomized Controlled Clinical Trial［J］. Drug Des Devel Ther， 2023，17：143-153. doi:10.2147/dddt.s392569 |
| 23 | DOI M， MORITA K， TAKEDA J， et al. Efficacy and safety of remimazolam versus propofol for general anesthesia： a multicenter， single-blind， randomized， parallel-group， phase Ⅱb/Ⅲtrial［J］. J Anesth， 2020，34（4）：543-553. doi:10.1007/s00540-020-02788-6 |
| 24 | DAI G， PEI L， DUAN F， et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia［J］. Minerva Anestesiol， 2021，87（10）：1073-1079. doi:10.23736/s0375-9393.21.15517-8 |
| 25 | 王惠军， 熊军， 包音，等. 瑞马唑仑用于五官科手术患者喉罩全身麻醉的效果［J］. 中国医药导报，2022，19（24）：115-118， 123. |
/
| 〈 |
|
〉 |