目的 探讨瑞马唑仑对腹腔镜人工CO₂气腹复合Trendelenburg体位下腹部和盆腔手术患者术中颅内压和脑氧合变化的影响。 方法 88例行拟腹腔镜下行下腹部及盆腔手术患者随机分为瑞马唑仑组（44例）及七氟醚组（44例）。瑞马唑仑组持续泵注瑞马唑仑1 mg/（kg·h）维持麻醉，七氟醚组患者吸入2%七氟醚维持麻醉。观察并记录两组患者麻醉诱导前（T₀）、麻醉诱导后5 min（T₁）、气腹头低位10 min（T₂）、30 min（T₃）、60 min（T₄）、放气腹平卧位后30 min（T₅）时的HR、MAP、气道峰压（Peak）、气道平台压（Plat）、P_ETCO₂、rSO₂以及双眼ONSD水平。 结果 两组患者在各时间点的HR、MAP、Peak、Plat和P_ETCO₂的组间比较差异无统计学意义（P > 0.05）。在T₂ ~ T₄时，两组患者的Peak、Plat均显著高于T₁，差异有统计学意义（P < 0.05）；T₀和T₁时刻两组患者ONSD组间比较差异无统计学意义（P > 0.05）。T₂ ~ T₅时刻两组患者ONSD均较T₀时显著升高，并随着气腹和Trendelenburg体位时间的延长而逐渐升高，在T₅时刻略有下降，差异有统计学意义（P < 0.05）；T₃、T₄时刻瑞马唑仑组患者ONSD明显小于七氟醚组，差异有统计学意义（P < 0.05）。两组患者rSO₂在研究观察期间的组间比较差异无统计学意义（P > 0.05）。 结论 在腹腔镜Trendelenburg体位下腹部和盆腔手术中，与吸入七氟醚维持麻醉相比，瑞马唑仑静脉麻醉可一定程度减轻颅内压的升高。

Objective To explore the impacts of remimazolam on intraoperative intracranial pressure （ICP） and cerebral oxygenation in patients undergoing laparoscopic lower abdominal and pelvic surgery under CO₂ pneumoperitoneum combined with Trendelenburg position. Methods Eighty-eight patients scheduled to undergo laparoscopic lower abdominal and pelvic surgery were randomly assigned to the remimazolam group （n = 44） and the sevoflurane group （n = 44）. In the remimazolam group， continuous infusion of remimazolam at a rate of 1 mg/（kg·h） was administered for anesthesia maintenance. In contrast， the sevoflurane group inhaled 2% sevoflurane. Heart rate （HR）， mean arterial pressure （MAP）， peak airway pressure （Peak）， plateau airway pressure （Plat）， end-tidal CO₂ （P_ETCO₂）， regional cerebral oxygen saturation （rSO₂）， and optic nerve sheath diameter （ONSD）of both eyes were measured and recorded at the following time points： prior to anesthesia induction （T₀）， 5 minutes after induction （T₁）， 10 minutes （T₂）， 30 minutes （T₃）， and 60 minutes （T₄） after the establishment of pneumoperitoneum in Trendelenburg position， as well as 30 minutes after deflation in the supine position （T₅）. Results No significant intergroup differences were detected in HR， MAP， Peak， Plat， or P_ETCO₂ at any time point （P > 0.05）. In both groups， Peak and Plat values were significantly higher at T₂-T₄ compared to T₁ （P < 0.05）. Regarding the ONSD） no intergroup differences were noted at T₀ and T₁ （P > 0.05）. From T₂ to T₅， ONSD in both groups increased significantly relative to T_0.. It gradually rose with the prolongation of pneumoperitoneum and Trendelenburg positioning and showed a slight decrease at T₅ （P < 0.05）. Specifically， at T₃ and T₄， the remimazolam group exhibited significantly smaller ONSD values than the sevoflurane group （P < 0.05）. Throughout the study， no intergroup differences in rSO₂ were observed （P > 0.05）. Conclusion In laparoscopic lower abdominal and pelvic surgeries performed in the Trendelenburg position， intravenous anesthesia with remimazolam may be more effective in mitigating the elevation of intracranial pressure compared to sevoflurane inhalation.