瑞马唑仑复合小剂量丙泊酚诱导麻醉肝癌切除术患者镇静和认知功能恢复比较研究*

doi:10.3969/j.issn.1672-5069.2024.06.031

摘要/Abstract

摘要： 目的研究瑞马唑仑复合小剂量丙泊酚诱导麻醉肝癌切除术患者镇静和认知功能恢复情况。方法 2020年1月～2024年1月我院收治的原发性肝癌(PLC)患者80例,均接受肝癌切除术治疗。在麻醉诱导期,随机将患者分为A组40例和B组40例,分别给予咪达唑仑、舒芬太尼、丙泊酚(2.0 mg·kg^-1)和罗库溴铵,或瑞马唑仑和丙泊酚(0.5 mg·kg^-1)静脉注射。两组麻醉维持用药相同。于麻醉诱导前(T₀)、麻醉诱导后(T₁)、插管时(T₂)和手术结束时(T₃),应用Riker镇静-躁动评分(SAS)和简易精神状态检查量表(MMSE)评分评估镇静效果和术后认知功能恢复情况。结果术后两组睁眼时间、拔管时间和麻醉恢复室停留时间比较无显著性差异(P>0.05);在T₂时刻,B组平均动脉压和心率分别为(80.1±7.5)mmHg和(71.9±8.1)次/min,显著低于A组【分别为(84.5±8.3)mmHg和(76.7±8.0)次/min,P<0.05】;在拔除气管导管后1 min、5 min和10 min,B组SAS评分分别为(3.2±0.4)分、(3.6±0.5)分和(3.7±0.6)分,均显著低于A组【分别为(3.9±0.7)分、(4.2±0.8)分和(4.5±0.9)分,P<0.05】;在术后6 h,B组MMSE评分为(25.7±3.0)分,显著高于A组【(22.5±2.1)分,P<0.05】;术后,B组不良反应发生率为2.5%,显著低于A组的17.5%(P<0.05)。结论应用瑞马唑仑复合小剂量丙泊酚麻醉诱导能够维持肝癌切除手术患者血流动力学稳定,提高镇静效果,有助于术后认知功能的恢复。

关键词: 原发性肝癌, 肝癌切除术, 麻醉诱导, 瑞马唑仑, 丙泊酚, 麻醉

Abstract: Objective The aim of this study was to investigate remimazolam and low-dose of propofol combination in induction of general anesthesia in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods 80 patients with PLC were encountered in our hospital between January 2020 and January 2024, and all underwent hepatectomy. For induction of anesthesia, we assigned patients into group A (n=40), receiving combination agents, and group B (n=40), receiving remimazolam and low-dose of propofol, intravenously. All patients received routine anesthesia maintenance. Before anesthesia induction (T₀), after anesthesia induction (T₁), at intubation (T₂) and at end of surgery (T₃), sedation and postoperative cognitive function were evaluated by using Riker sedation/anxiety scale (SAS) and mini mental state examination (MMSE) scale. Results There was no significant differences in eye-opening time, extubation time and post-anesthesia care unit stay between the two groups (P>0.05); by T₂, mean arterial pressure and heart rate in group B were(80.1±7.5)mmHg and (71.9±8.1)beats/min, both significantly lower than [(84.5±8.3)mmHg and (76.7±8.0)beats/min, respectively, P<0.05] in group A; by 1 min, 5 min and 10 min after removal of tracheal catheter, SAS scores in group B were (3.2±0.4)points, (3.6±0.5)points and (3.7±0.6)points, all significantly lower than [(3.9±0.7)points, (4.2±0.8)points and (4.5±0.9)points, respectively, P<0.05] in group A; by 6 hours after operation, MMSE score in group B was (25.7±3.0)points, much higher than [(22.5±2.1)points, P<0.05] in group A; post-operationally, adverse effect in group B was 2.5%, much lower than 17.5%(P<0.05) in group A. Conclusion Combination of remimazolam and low-dose of propofol in induction of general anesthesia in patients with PLC undergoing hepatectomy could maintain hemodynamic stability, improve sedation and cognitive function restoration.

Key words: Hepatoma, Hepatectomy, Induction of general anesthesia, Remimazolam, Propofol, Anesthesia

陶巧建, 仲华根, 周绍荣, 潘洪喜, 王应杰. 瑞马唑仑复合小剂量丙泊酚诱导麻醉肝癌切除术患者镇静和认知功能恢复比较研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 923-926.

Tao Qiaojian, Zhong Huagen, Zhou Shaorong, et al. Remimazolam and low-dose of propofol in induction of general anesthesia in patients with primary liver cancer undergoing hepatectomy[J]. Journal of Practical Hepatology, 2024, 27(6): 923-926.

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瑞马唑仑复合小剂量丙泊酚诱导麻醉肝癌切除术患者镇静和认知功能恢复比较研究^*

Remimazolam and low-dose of propofol in induction of general anesthesia in patients with primary liver cancer undergoing hepatectomy

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