目的 探讨近日节律对甲苯磺酸瑞马唑仑全麻手术患者麻醉诱导期镇静深度的影响。 方法 选取年龄18 ~ 65岁全身麻醉下行择期手术的患者，根据麻醉诱导开始时间将患者分为日间组（7：00 ~ 19：00）和夜间组（19：00至次日7：00），每组70例，每组再分为0.11、0.13、0.16、0.18 和0.22 mg/kg 5个等比亚剂量组，每个亚组各14例。观察给药3 min后的MOAA/S 评分和脑电双频指数（BIS）值，计算两者的相关系数，记录MOAA/S 评分≤ 1时甲苯磺酸瑞马唑仑的诱导剂量和单位体质量剂量，记录日间组和夜间组以及不同性别患者日间和夜间瑞马唑仑的诱导剂量，计算日间组和夜间组的半数有效量（ED₅₀）、95%有效量（ED₉₅）及其95%置信区间（CI）。 结果 当MOAA/S ≤ 1时，与日间组（13.98 ± 4.21）mg相比，夜间组瑞马唑仑的诱导剂量（12.34 ± 3.51）mg减少，与日间组（0.22 ± 0.056）mg/kg相比，夜间组瑞马唑仑的单位体质量剂量（0.20 ± 0.049）mg/kg减少，日间组与夜间组瑞马唑仑的ED₅₀和ED₉₅差异有统计学意义（P < 0.05）；日间组BIS与MOAA/S相关系数为0.902（95%CI：0.876 ~ 0.925），夜间组BIS与MOAA/S相关系数为0.905（95%CI：0.888 ~ 0.927），两组MOAA/S与BIS呈极强相关性，组间相关系数差异无统计学意义（P > 0.05）；日间组女性患者BIS与MOAA/S相关系数为0.763（95%CI：0.726 ~ 0.799），夜间组女性患者BIS与MOAA/S相关系数为0.777（95%CI：0.739 ~ 0.808）。日间组男性患者BIS与MOAA/S相关系数为0.768（95%CI：0.723 ~ 0.804），夜间组男性患者BIS与MOAA/S相关系数为0.771（95%CI：0.723 ~ 0.811）。男性患者和女性患者日间组和夜间组的MOAA/S与BIS呈强相关性，组间相关系数差异无统计学意义（P > 0.05）；夜间组的BIS明显降低，差异有统计学意义（P < 0.05）；男性患者瑞马唑仑总诱导剂量在日间和夜间均高于女性患者，差异有统计学意义（P < 0.05）；女性患者夜间组的BIS值明显降低（P < 0.05）。 结论 近日节律对甲苯磺酸瑞马唑仑全麻手术患者麻醉诱导镇静效应产生影响，夜间组患者的镇静效应更强，并且存在性别的差异，夜间女性患者的镇静效果更好。

Objective To investigate the impact of recent rhythmic interventions on the depth of sedation during anesthesia induction in patients undergoing general anesthesia with remazolam toluene sulfonate. Methods Patients aged 18 ~ 65 years who underwent elective surgery under general anesthesia were selected and divided into a day group （7：00 ~ 19：00） and a night group （19：00 ~ 7：00 the following day） based on the start time of anesthesia induction. Each group comprised 70 patients， further subdivided into five equal dose groups of remazolam toluene sulfonate at 0.11， 0.13， 0.16， 0.18， and 0.22 mg/kg， with 14 patients in each subgroup. The Modified Observer's Assessment of Alertness/Sedation （MOAA/S） score and Bispectral Index （BIS） value were recorded 3 minutes post?administration， and the correlation coefficient between these two parameters was calculated. The induction dose and unit body weight dose of remazolam toluene sulfonate were documented when the MOAA/S score was ≤ 1. Additionally， the induction dose of remazolam for both day and night groups as well as for patients of different genders was recorded. The half effective dose （ED50）， 95% effective dose （ED95）， and 95% confidence interval （CI） for both the day and night groups were also calculated. Results When MOAA/S ≤ 1， the induced dose of remazolam in the night group （12.34 ± 3.51） mg was significantly lower than that in the day group （13.98 ± 4.21） mg. Additionally， the dose per unit body weight of remazolam in the night group （0.20 ± 0.049） mg/kg was also significantly lower than that in the day group （0.22 ± 0.056） mg/kg. Statistically significant differences were observed in the ED50 and ED95 values of remazolam between the day and night groups （P < 0.05）. The correlation coefficient between BIS and MOAA/S was 0.902 （95%CI： 0.876 ~ 0.925） in the day group and 0.905 （95%CI： 0.879 ~ 0.929） in the night group， indicating a strong correlation between MOAA/S and BIS in both groups. However， there was no significant difference in the correlation coefficients between the two groups （P > 0.05）. The correlation coefficients between BIS and MOAA/S were 0.763 （95%CI： 0.726 ~ 0.799） in the daytime group and 0.777 （95%CI： 0.739 ~ 0.808） in the nighttime group. In a separate analysis， the correlation coefficients were 0.768 （95% CI： 0.723 ~ 0.804） for the daytime group and 0.771 （95% CI： 0.723 ~ 0.811） for the nighttime group. A strong correlation was observed between MOAA/S and BIS in both male and female patients during both day and night， with no significant difference in correlation coefficients between groups （P > 0.05）. However， BIS values were significantly lower in the nighttime group compared to the daytime group （P < 0.05）. Additionally， male patients required a higher total induced dose of remazolam than female patients during both day and night， with this difference being statistically significant （P < 0.05）. Furthermore， female patients exhibited a significant decrease in BIS values at night （P < 0.05）. Conclusions Recent studies have shown that circadian rhythm significantly influences anesthesia?induced sedation in patients undergoing general anesthesia with remazolam toluenesulfonate. Specifically， the sedation effect is more pronounced in nighttime procedures， and there is a notable gender difference， with female patients exhibiting better sedation outcomes during nighttime surgeries.