瑞马唑仑与七氟醚维持麻醉对腹腔镜Trendelenburg体位手术患者颅内压和脑氧合的影响

doi:10.3969/j.issn.1006-5725.2025.13.021

Abstract

Abstract:

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-T₄compared to T₁（P < 0.05）. Regarding the ONSD） no intergroup differences were noted at T₀and 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.

Key words: trendelenburg position, remimazolam, sevoflurane, optic nerve sheath diameter, intracranial pressure

CLC Number:

R614.2

Junpeng LIU,Shiya LIU,Zhen ZHANG,Changhong MIAO,Xihua. LU. Effects of remimazolam and sevoflurane anesthesia on intracranial pressure and cerebral oxygenation in patients undergoinglaparoscopicsurgery in trendelenburg position[J]. The Journal of Practical Medicine, 2025, 41(13): 2088-2093.

Figures/Tables 5

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References 24

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项目	RM组（n = 43）	S组（n = 43）	t/χ²值	P值
性别/例			0.828	0.414
男	20	18
女	23	25
ASA分级/例			0.616	0.308
Ⅰ级	9	12
Ⅱ级	34	31
年龄/岁	57.0 ± 5.1	58.0 ± 4.6	-0.980	0.330
BMI/（kg/m²）	21.5 ± 1.5	21.2 ± 1.7	0.791	0.431

项目	RM组（n = 43）	S组（n = 43）	t/χ²值	P值
头低位时间/min	77 ± 13	81 ± 15	-1.557	0.123
头低位角度/°	24.1 ± 5.7	22.9 ± 5.6	0.946	0.347
液体入量/mL	1430 ± 221	1366 ± 186	1.851	0.068
液体出量/mL	701 ± 140	665 ± 130	1.238	0.219

项目	时间	RM组（n = 43）	S组（n = 43）	t/Z值	P值
HR/（次/min）	T₁	74.3 ± 15.1	71.7 ± 13.7	0.808	0.421
	T₂	70.0 ± 10.6	66.6 ± 13.3	1.314	0.192
	T₃	73.3 ± 10.3	71.0 ± 8.3	1.150	0.253
	T₄	70.1 ± 8.9	68.5 ± 7.6	0.893	0.374
	T₅	69.8 ± 8.9	67.4 ± 7.1	1.407	0.163
MAP/mmHg	T₁	77.7 ± 8.2	74.8 ± 8.8	1.611	0.111
	T₂	79.2 ± 8.4	76.3 ± 7.4	1.719	0.089
	T₃	81.2 ± 8.1	77.6 ± 10.1	1.813	0.073
	T₄	77.8 ± 8.2	74.5 ± 8.7	1.844	0.069
	T₅	73.8 ± 9.4	71.4 ± 7.5	1.334	0.186
BIS/［M（IQR）］	T₁	45（4）	44（5）	-1.521	0.128
	T²	45（6）	45（7）	-0.617	0.538
	T₃	45（9）	46（8）	0.412	0.681
	T₄	48（7）	48（6）	-0.823	0.411
	T₅	47（11）	50（9）	1.191	0.234
Peak/cmH₂O	T₁	16.4 ± 2.5	17.0 ± 2.4	-1.178	0.242
	T₂	26.9 ± 5.1^?	28.0 ± 4.9^?	-0.987	0.327
	T₃	24.7 ± 5.3^?	26.1 ± 5.0^?	-1.181	0.241
	T₄	24.1 ± 4.4^?	25.4 ± 5.1^?	-1.318	0.191
	T₅	18.9 ± 3.3	19.7 ± 2.2	-0.723	0.472
Plat/cmH₂O	T₁	13.8 ± 3.3	14.9 ± 2.9	-1.549	0.125
	T₂	21.8 ± 3.1^?	22.7 ± 3.4^?	-1.249	0.215
	T₃	20.9 ± 3.1^?	21.9 ± 3.6^?	-1.432	0.156
	T₄	19.6 ± 3.1^?	20.8 ± 3.6^?	-1.660	0.101
	T₅	14.9 ± 2.6	16.0 ± 2.7	-1.942	0.055
P_ETCO₂/cmH₂O	T₁	40.3 ± 2.6	39.4 ± 2.5	1.659	0.101
	T₂	39.8 ± 2.6	39.1 ± 2.6	0.728	0.189
	T₃	39.4 ± 2.6	40.3 ± 2.5	-1.720	0.089
	T₄	39.2 ± 2.5	38.4 ± 2.3	1.486	0.141
	T₅	39.9 ± 2.3	39.2 ± 2.5	1.338	0.184

时间	RM组（n = 43）	S组（n = 43）	t值	P值
T₀	4.58 ± 0.45	4.45 ± 0.52	1.222	0.225
T₁	4.70 ± 0.43	4.54 ± 0.55	1.518	0.133
T₂	5.03 ± 0.52^?	4.96 ± 0.47^?	0.717	0.475
T₃	5.11 ± 0.46^?	5.38 ± 0.43^?	-2.833	0.006
T₄	5.23 ± 0.53^?	5.53 ± 0.54^?	-2.451	0.016
T₅	4.98 ± 0.40^?	5.13 ± 0.37	-1.783	0.078

时间	RM组（n = 43）	S组（n = 43）	t值	P值
T₀	65.8 ± 4.1	64.7 ± 4.8	1.118	0.267
T₁	74.2 ± 6.6^?	72.9 ± 5.8^?	0.938	0.351
T₂	72.6 ± 6.2^?	71.2 ± 5.4^?	1.133	0.261
T₃	70.5 ± 6.2^?	68.9 ± 5.8^?	1.181	0.241
T₄	71.5 ± 5.9^?	69.8 ± 6.0^?	1.266	0.209
T₅	72.1 ± 5.8^?	69.9 ± 5.4^?	1.795	0.076

Effects of remimazolam and sevoflurane anesthesia on intracranial pressure and cerebral oxygenation in patients undergoinglaparoscopicsurgery in trendelenburg position

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