马达 贾广锐 张庆洪

【摘要】 目的：探究瑞馬唑仑、丙泊酚在气管插管全身麻醉老年腹部手术患者中的应用效果。方法：选取2022年1—10月厦门大学附属第一医院收治的110例老年腹部手术患者作为研究对象，用随机数字表法分为瑞马唑仑组和丙泊酚组，每组55例。瑞马唑仑组用瑞马唑仑进行麻醉诱导及麻醉维持，丙泊酚组患者用丙泊酚进行麻醉诱导及麻醉维持。观察两组不同时间点血流动力学[心率（HR）、平均动脉压（MAP）]及术中相关药物使用情况（去甲肾上腺素用量、多巴胺用量）、不同时间点呼吸抑制情况[呼吸频率（RR）、经皮动脉血氧饱和度（SpO2）]和微循环灌注情况（血乳酸浓度），以及术后苏醒质量[苏醒时间、Richmond躁动-镇静评分（RASS）]。结果：两组T1、T2、T3时的SpO2及T2、T3时的RR比较，差异均无统计学意义（P>0.05）；瑞马唑仑组T1、T2、T3时的HR、MAP及T1时的RR均高于丙泊酚组，差异均有统计学意义（P<0.05）；瑞马唑仑组去甲肾上腺素用量、多巴胺用量均少于丙泊酚组，血乳酸浓度低于丙泊酚组，苏醒时间短于丙泊酚组，平静率高于丙泊酚组，差异均有统计学意义（P<0.05）。结论：瑞马唑仑应用于气管插管全身麻醉老年患者腹部手术中，较丙泊酚对血液流动学及呼吸抑制的影响更小，术后苏醒质量更高。

【关键词】 瑞马唑仑 丙泊酚 气管插管全身麻醉

Comparison of the Application of Remimazolam and Propofol in Elderly Patients Undergoing Abdominal Surgery under Tracheal Intubation General Anesthesia/MA Da， JIA Guangrui， ZHANG Qinghong. //Medical Innovation of China， 2024， 21（08）： -125

[Abstract] Objective： To explore the application effect of Remimazolam and Propofol in elderly patients underwent abdominal surgery under tracheal intubation general anesthesia. Method： A total of 110 elderly patients underwent abdominal surgery admitted to the First Affiliated Hospital of Xiamen University from January to October 2022 were selected as the study objects and divided into Remimazolam group and Propofol group according to random number table method， with 55 cases in each group. Remimazolam group was treated with Remimazolam for anesthesia induction and maintenance， and Propofol group was treated with Propofol for anesthesia induction and maintenance. Hemodynamics [heart rate （HR）， mean arterial pressure （MAP）]， intraoperative related drugs use situation （Norepinephrine dosage， Dopamine dosage）， respiratory depression situation at different time points [respiratory rate （RR）， percutaneous arterial oxygen saturation （SpO2）] and microcirculation perfusion situation （blood lactic acid concentration） and the quality of postoperative recovery [recovery time， Richmond agitation and sedation scale （RASS）] of the two groups were observed. Result： There were no significant differences in SpO2 at T1， T2 and T3 and RR at T2 and T3 between the two groups （P>0.05）. HR， MAP at T1， T2， T3 and RR at T1 in Remimazolam group were higher than those in Propofol group， the differences were statistically significant （P<0.05）. The dosage of Norepinephrine and Dopamine in Remimazolam group were lower than those in Propofol group， the blood lactic acid concentration was lower than that in Propofol group， the recovery time was shorter than that in Propofol group， and the calm rate was higher than that in Propofol group， the differences were statistically significant （P<0.05）. Conclusion： Compared with Propofol， the application of Remimazolam in abdominal surgery for elderly patients under tracheal intubation general anesthesia has less influence on hemodynamics and respiratory depression， and the quality of postoperative recovery is higher.

[Key words] Remimazolam Propofol Tracheal intubation general anesthesia

First-author's address： Department of Anesthesiology， the First Affiliated Hospital of Xiamen University， Xiamen 361000， China

doi：10.3969/j.issn.1674-4985.2024.08.027

腹部手术为临床常见手术类型，包含胃、肠、胆囊、阑尾的切除等，因多数腹部手术创伤较大，为保障患者术中安全，一般采取全身麻醉。全身麻醉以吸入、静脉和复合麻醉方式抑制患者中枢神经系统，实现手术全程意识消失及全身无痛，故其麻醉药物使用剂量及相关不良反应发生风险也远超局部麻醉[1]。老年患者机体各器官功能逐步衰退，且多伴有高血压、冠心病等心血管疾病，全身麻醉后中枢抑制作用可能引发血流动力学波动及呼吸抑制，提高其手术风险；同时老年患者代谢功能较差，麻醉药物代谢时间减慢，往往会升高蘇醒躁动发生风险[2]，引发碰撞伤害、意外坠床等不良事件，不利于其预后。因此……