瑞马唑仑复合环泊酚麻醉腹腔镜下肝脏部分切除术治疗肝内胆管结石患者麻醉效果研究*

doi:10.3969/j.issn.1672-5069.2026.04.039

摘要/Abstract

摘要： 目的观察应用瑞马唑仑复合环泊酚麻醉腹腔镜下肝脏部分切除术治疗肝内胆管结石患者麻醉效果。方法 2023年12月～2025年6月我院收治的肝内胆管结石患者119例,均接受腹腔镜下肝脏部分切除术治疗。随机将患者分为两组,分别给予环泊酚(C组,n=60)或瑞马唑仑复合环泊酚(RC组,n=59)麻醉。采用ELISA法检测血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)和去甲肾上腺素(NE)水平,使用流式细胞仪检测外周血CD3⁺、CD4⁺和CD8⁺细胞百分比,并计算CD4⁺/CD8⁺细胞比值。应用简易智力状态检测量表(MMSE)评估认知功能。结果在术后3 d,RC组血清Cor、ACTH和NE水平分别为(240.9±42.6)mmol/L、(19.3±3.9)pmol/L和(2.8±0.6)pg/mL,均显著低于C组【分别为(288.2±55.7)mmol/L、(24.4±5.3)pmol/L和(3.4±0.7)pg/mL,P<0.05】;RC组MMSE评分为(28.6±1.9)分,与C组【(28.0±1.6)分,P>0.05】比较无显著性差异;RC组外周血CD3⁺、CD4⁺和CD8⁺细胞百分比和CD4⁺/CD8⁺细胞比值分别为(68.2±8.7)%、(42.0±8.3)%、(23.7±5.9)%和(1.9±0.7),与C组【分别为(66.9±9.1)%、(40.4±7.8)%、(24.3±6.1)%和(1.8±0.7)】比,均无显著性差异(P>0.05);RC组低血压发生率为8.5%,显著低于C组的21.7%(P<0.05),但两组并发症总发生率(22.0%对36.7%)比较无显著性差异(P>0.05)。结论应用瑞马唑仑复合环泊酚麻醉能够有效抑制腹腔镜下肝脏部分切除术患者应激反应,而对术后认知和淋巴细胞功能无不良影响。

关键词: 肝内胆管结石, 腹腔镜肝脏部分切除术, 瑞马唑仑, 环泊酚, 应激反应, 认知功能, 麻醉

Abstract: Objective The aim of this study was to investigate anesthetic efficacy of remimazolam and ciprofol combination in patients with intrahepatic bile duct stones (IHBDS) undergoing laparoscopic partial hepatectomy (LPH). Methods 119 patients with IHBDS were encountered in our hospital between December 2023 and June 2025, and all underwent LPH for resection of intrahepatic tumors. Patients were randomly divided into two groups, receiving ciprofol (group C, n=60) or remimazolam and ciprofol combination (group RC, n=59) intravenous anesthesia. Serum cortisol (Cor), adrenocorticotropic hormone (ACTH) and norepinephrine (NE) levels were measured by ELISA, and peripheral blood CD3⁺, CD4⁺ and CD8⁺ cell percentages were detected by flow cytometry, and CD4⁺/CD8⁺ cell ratio was calculated. The cognitive function was evaluated by mini-mental state examination (MMSE). Results By end of three days after operation, serum Cor, ACTH and NE levels in group RC were (240.9±42.6)mmol/L, (19.3±3.9)pmol/L and (2.8±0.6)pg/mL, all significantly lower than [(288.2±55.7) mmol/L, (24.4±5.3) pmol/L and (3.4±0.7)pg/mL, respectively, P<0.05] in group C; MMSE score in group RC was (28.6±1.9), not significantly different as compared to [(28.0±1.6), P>0.05] in group C; percentages of peripheral blood CD3⁺, CD4⁺ and CD8⁺ cells, and CD4⁺/CD8⁺ cell ratio in group RC were (68.2±8.7)%, (42.0±8.3)%, (23.7±5.9)%, and (1.9±0.7), all not significantly different compared to [(66.9±9.1)%,(40.4±7.8)%,(24.3±6.1)%, and (1.8±0.7), P>0.05] in group C; incidence of hypotension during operation in group RC was 8.5%,much lower than 21.7%(P<0.05) in group C,while there was no significant difference as respect to total incidence of complications (22.0% vs. 36.7%)between the two groups(P>0.05). Conclusion Application of remimazolam in combination with ciprofol anesthesia could effectively inhibit body stress reactions in patients with undergoing LPH, which don’t impact postoperative cognitive functions.

Key words: Intrahepatic bile duct stones, Laparoscopic partial hepatectomy, Remimazolam, Ciprofol, Stress response, Cognition, Anesthesia

赵仕亮, 刘昆洋, 王晓军. 瑞马唑仑复合环泊酚麻醉腹腔镜下肝脏部分切除术治疗肝内胆管结石患者麻醉效果研究^*[J]. 实用肝脏病杂志, 2026, 29(4): 633-636.

Zhao Shiliang, Liu Kunyang, Wang Xiaojun. Anesthetic efficacy of remimazolam and ciprofol combination in patients with intrahepatic bile duct stones undergoing laparoscopic partial hepatectomy[J]. Journal of Practical Hepatology, 2026, 29(4): 633-636.

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瑞马唑仑复合环泊酚麻醉腹腔镜下肝脏部分切除术治疗肝内胆管结石患者麻醉效果研究^*

Anesthetic efficacy of remimazolam and ciprofol combination in patients with intrahepatic bile duct stones undergoing laparoscopic partial hepatectomy

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