不同剂量苯磺酸瑞马唑仑麻醉诱导用于老年患者腹腔镜胆囊切除术的效果分析

Analysis of the Effects of Different Doses of Remimazolam Besylate for Anesthesia Induction in Elderly Patients Undergoing Laparoscopic Cholecystectomy

摘要

目的 分析老年腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）患者麻醉诱导中应用不同剂量苯磺酸瑞马唑仑对其术后认知功能、麻醉效果、镇静深度、血流动力学及不良反应的影响。方法 选取 2023 年 5 月至 2024 年 5 月江山市人民医院收治的 120 例 LC 老年患者，以随机数字表法分为 3 组，40 例 A 组患者采用 0.1 mg·kg^-1 苯磺酸瑞马唑仑进行麻醉诱导，40 例 B 组患者采用 0.15 mg·kg^-1 苯磺酸瑞马唑仑进行麻醉诱导，40 例 C 组患者采用 0.2 mg·kg^-1 苯磺酸瑞马唑仑进行麻醉诱导。对比 3 组的麻醉效果、镇静深度、血流动力学指标、认知功能及不良反应。结果 B 组意识消失时间较 A 组更短，补救镇静率较 A 组更低（P< 0.05）；C 组意识消失时间较 A 组、B 组更短，补救镇静率较 A 组、B 组更低（P< 0.05）。入室时（T0）、插管即刻（T1）、插管后 1 min （T2）、插管后 5 min （T3）及切皮即刻（T4），3 组的平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）水平无统计学差异（P> 0.05）。3 组用药后 1 和 5 min 脑电双频指数（bispectral index，BIS）、改良警觉/镇静评分量表（Modified Observer,s Assessment of Alertness/Sedation Scale，MOAA/S）评分较同组麻醉诱导前均降低（P< 0.05）；3 组用药后 5 min 的 BIS 值、MOAA/S 评分较同组用药后 1 min 降低（P< 0.05）。B 组用药后 1 和 5 min 的 BIS 值、MOAA/S 评分较 A 组更低（P< 0.05）；C 组用药后 1 和 5 min 的 BIS 值、MOAA/S 评分低于 A 组、B 组（P< 0.05）。3 组术后 1 d 的简易智力状态检查量表（Mini-mental State Examination，MMSE）、蒙特利尔认知功能评估量表（Montreal Cognitive Assessment Scale，MoCA）评分低于同组术前（校正后P< 0.05），术后 3 d 的 MMSE、MoCA 评分高于同组术后 1 d （校正后P< 0.05）；3 组内术前与术后 3 d 的 MMSE、MoCA 评分比较，差异无统计学意义（校正后P> 0.05）；3 组间术前、术后 1 d 及术后 3 d 的 MMSE、MoCA 评分比较，差异无统计学意义（校正后P> 0.05）。3 组不良反应差异无统计学意义（P> 0.05）。结论 LC 老年患者麻醉诱导中应用 0.2 mg·kg^-1 苯磺酸瑞马唑仑，相较于 0.1 及 0.15 mg·kg^-1 的剂量，可取得更理想的镇静深度，稳定血流动力学指标，缩短麻醉起效时间，且对认知功能影响较小，不会增加不良反应。

Abstract

Objective To analyze the effects of different doses of remimazolam besylate during anesthesia induction on postoperative cognitive function, anesthetic efficacy, sedation depth, hemodynamics, and adverse reactions in elderly patients undergoing laparoscopic cholecystectomy (LC). Methods From May 2023 to May 2024, 120 elderly patients with LC admitted to Jiangshan People,s Hospital were selected and divided into 3 groups by random number table method. 40 patients in group A were given 0.1 mg∙kg^-1 remimazolam besylate for anesthesia induction, 40 patients in group B were given 0.15 mg∙kg^-1 remimazolam besylate for anesthesia induction, and 40 patients in group C were given 0.2 mg∙kg^-1 remimazolam besylate for anesthesia induction. The anesthesia effects, sedation depth, hemodynamic indicators, cognitive function and adverse reactions of the three groups were compared. Results The time of consciousness disappearance in Group B was shorter than that in Group A, and the rate of rescue sedation was lower in Group B (P < 0.05); the time of consciousness disappearance in Group C was shorter than that in Group A and Group B, and the rate of rescue sedation was lower in Group C (P < 0.05). There were no statistically significant differences in mean arterial pressure (MAP) and heart rate (HR) levels among the three groups at the time of admission (T0), immediately after intubation (T1), 1 minute after intubation (T2), 5 minutes after intubation (T3), and immediately after skin incision (T4) (P > 0.05). In all three groups, the bispectral index (BIS) values and Modified Observer,s Assessment of Alertness/Sedation Scale (MOAA/S) scores at 1 min and 5 min after medication were lower than those before anesthesia induction within the same group (P < 0.05). The BIS values and MOAA/S scores at 5 min after medication were lower than those at 1 min after medication within the same group (P< 0.05). The BIS values and MOAA/S scores of Group B at 1 and 5 minutes after medication were lower than those of Group A (P < 0.05). The BIS values and MOAA/S scores of Group C at 1 and 5 minutes after medication were lower than those of Group A and Group B (P < 0.05). In each group, the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) scores on postoperative day 1 were lower than those before surgery (corrected P < 0.05), and the scores on postoperative day 3 were higher than those on postoperative day 1 (corrected P< 0.05). There was no statistically significant difference in MMSE and MoCA scores between before surgery and postoperative day 3 within each group (correctedP > 0.05). Among the three groups, there were no statistically significant differences in MMSE and MoCA scores before surgery, on postoperative day 1, or on postoperative day 3 (corrected P > 0.05). There was no statistical difference in adverse reactions among the three groups (P > 0.05). Conclusion In the anesthesia induction of elderly patients with LC, 0.2 mg∙kg^-1 remimazolam besylate, compared with 0.1 and 0.15 mg∙kg^-1, can achieve a more ideal sedation depth, stabilize hemodynamic indicators, shorten the onset time of anesthesia, and have a smaller impact on cognitive function, without increasing adverse reactions.

关键词

苯磺酸瑞马唑仑 / 腹腔镜胆囊切除术 / 麻醉诱导 / 认知功能

Key words

remimazolam besylate / laparoscopic cholecystectomy / anesthesia induction / cognitive function

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