目的 评价瑞马唑仑快通道麻醉对心脏瓣膜手术患者术后早期恢复质量的改善情况，为临床优化快通道麻醉和术后快速康复（ERAS）方案提供参考依据。 方法 选择全麻体外循环下行正中开胸心脏瓣膜置换和（或）成形术的择期手术患者，在常规麻醉评估和快通道麻醉适应证评估基础上，严格按照纳入标准和排除标准入组研究对象228例，随机分为两组：瑞马唑仑组、异丙酚组，每组114例。瑞马唑仑组患者麻醉诱导与麻醉维持均使用瑞马唑仑，对照组患者则使用异丙酚。记录患者的一般资料、手术资料等；记录术前1 d、术后1 d、术后3 d和出院前1 d的QoR-15评分；记录入室后主要时间点的血流动力学指标、麻醉后低血压及心动过缓的发生情况、手术持续时间、麻醉持续时间、术后机械通气时间、ICU 停留时间、术后住院时间等；以及围术期心血管不良事件的发生率以及术后近期并发症的发生率等。 结果 （1）两组间一般资料及术前1 d的QoR-15评分比较，差异无统计学意义（P > 0.05）。（2）瑞马唑仑组的QoR-15评分在出院前1 d与异丙酚组相比有所增高，差异有统计学意义（P < 0.05），但差异小于最小临床差异即小于8，无明显的临床获益。（3）气管插管后1 min及切皮后1 min异丙酚组心率减慢并且MAP明显降低，组间比较差异有统计学意义（P < 0.05）；其余时刻的心率、MAP差异无统计学意义（P > 0.05）。术中低血压和心动过缓发生率瑞马唑仑组低于异丙酚组，差异有统计学意义（P < 0.05）。术后机械通气时间、ICU停留时间、术后住院时间以及再次插管率瑞马唑仑组均短于异丙酚组，并且快通道麻醉成功率高于异丙酚组，差异有统计学意义（P < 0.05）。围术期并发症发生率方面两组差异无统计学意义。 结论 与常用的静脉麻醉药异丙酚相比，瑞马唑仑快通道麻醉方案虽未明显改善心脏瓣膜手术患者术后恢复质量评分，但瑞马唑仑在维持循环稳定、提高快通道麻醉成功率、缩短术后ICU停留时间和术后住院时间等方面具有明显优势。对于心脏手术患者来说，瑞马唑仑是可供选择的静脉麻醉药。

Objective To evaluate the improvement in the quality of early postoperative recovery in patients undergoing cardiac valve surgery with remimazolam?based fast?track anesthesia， and to provide a reference for the clinical optimization of fast?track anesthesia and Enhanced Recovery After Surgery （ERAS） protocols. Methods We selected elective surgery patients undergoing median sternotomy for cardiac valve replacement and/or repair under general anesthesia with extracorporeal circulation. Based on routine anesthesia assessment and fast?track anesthesia suitability assessment， a total of 228 patients were strictly enrolled according to the inclusion and exclusion criteria and randomly divided into two groups： the Remimazolam group （n = 114） and the Propofol group （n = 114）. Patients in the Remimazolam group were induced and maintained with remimazolam for anesthesia， while patients in the control group were administered propofol. We recorded the general information and surgical data of the patients； the QoR?15 scores before surgery （1 day preoperatively）， 1 day postoperatively， 3 days postoperatively， and 1 day before discharge； as well as hemodynamic parameters at key time points after admission， the incidence of hypotension and bradycardia after anesthesia， the duration of surgery， anesthesia duration， postoperative mechanical ventilation time， ICU stay， postoperative hospital stay， and the incidence of perioperative cardiovascular adverse events and the incidence of early postoperative complications. Results There was no statistically significant difference in general data and QoR?15 scores between the two groups 1 day before surgery （P > 0.05）. The QoR?15 score of the Remimazolam group 1 day before discharge was higher than that of the Propofol group， with a statistically significant difference （P < 0.05）， but the difference was less than the minimum clinically important difference， which is less than 8， indicating no significant clinical benefit. One minute after intubation and one minute after skin incision， the heart rate in the Propofol group slowed down and the Mean Arterial Pressure （MAP） significantly decreased， with a statistically significant difference between the groups （P < 0.05）； there was no statistically significant difference in heart rate and MAP at other times. The incidence of intraoperative hypotension and bradycardia was lower in the Remimazolam group than in the Propofol group， with a statistically significant difference （P < 0.05）. The duration of postoperative mechanical ventilation， ICU stay， postoperative hospital stay， and the rate of re?intubation were all shorter in the Remimazolam group than in the Propofol group， and the success rate of fast?track anesthesia was higher in the Remimazolam group， with a statistically significant difference （P < 0.05）. There was no statistically significant difference in the incidence of perioperative complications between the two groups. Conclusions Compared with the commonly used intravenous anesthetic propofol， the remimazolam?based fast?track anesthesia regimen did not significantly improve the postoperative recovery quality scores in patients undergoing cardiac valve surgery. However， remimazolam had advantages in maintaining hemodynamic stability， increasing the success rate of fast?track anesthesia， shortening postoperative ICU stay and hospital stay， and is a viable intravenous anesthetic option for cardiac surgery patients.