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

Abstract

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

CLC Number:

R614

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.

Figures/Tables 6

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References 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

Remimazolam versus propofol on quality of recovery after general anesthesia in elders undergoing ocular fundus daytime surgery

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项目	P组（n = 55）	R组（n = 55）	χ2值	P 值
注射痛	21（38）	0（0）	25.955	0.000
术中低血压	42（76）	9（16）	39.811	0.000
术后高血压	8（15）	8（15）	0.000	1.000
术后恶心呕吐	2（34）	0（0）	2.037	0.495
术后嗜睡	3（5）	4（7）	0.153	1.000

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