摘要
目的:探讨不同剂量瑞马唑仑对肝内外胆管结石手术患者麻醉效果及血流动力学的影响。方法:选取103例行肝内外胆管结石手术的患者为研究对象,采用瑞马唑仑麻醉,根据麻醉剂量不同分为低剂量组(0.2 mg/kg,n=52)及高剂量组(0.3 mg/kg,n=51)。比较两组患者麻醉效果、镇痛效果、氧化应激程度、血流动力学及不良反应发生情况。结果:低剂量组拔管时间及苏醒时间均短于高剂量组(P<0.05)。麻醉后,两组患者Ramsay评分均随时间发展而逐渐升高,且低剂量组Ramsay评分在麻醉15 min及麻醉30 min时均低于高剂量组(P<0.05)。术后6、12、24 h,高剂量组VAS评分均低于低剂量组,且两组患者VAS评分均随时间发展呈先升高后下降趋势(P<0.05)。术后1 d,两组患者过氧化氢(H_(2)O_(2))、人皮质醇(Cor)及丙二醛(MDA)水平均高于术前,且低剂量组各指标水平均低于高剂量组(P<0.05)。麻醉后15 min,两组患者舒张压、收缩压及心率水平均升高,高剂量组血氧饱和度降低,且低剂量组舒张压、收缩压及心率低于高剂量组,血氧饱和度高于高剂量组(P<0.05)。两组患者不良反应发生率无统计学差异(P>0.05)。结论:两种剂量瑞马唑仑麻醉均具有较高的麻醉、镇静及镇痛效果,但高剂量麻醉易导致患者血流动力学波动较大,易引起患者产生较大应激反应,因此对于肝内外胆管结石手术采用低剂量麻醉安全性更佳。
Objective:To investigate the effects of different doses of remazolam on anesthesia effect and hemodynamics in patients undergoing intrahepatic and extrahepatic bile duct stone surgery.Methods:All 103 patients undergoing intrahepatic and extrahepatic bile duct stone surgery were anesthesiated by remazolam and divided into low-dose group(0.2 mg/kg,n=52)and high-dose group(0.3 mg/kg,n=51)according to anesthesia dose.The anesthesia effect,analgesic effect,oxidative stress,hemodynamics,and adverse reactions of the two groups were compared.Results:The extubation time and awakening time in the low-dose group were shorter than those in the high-dose group(P<0.05).After anesthesia,the Ramsay score of both groups gradually increased with time,and the Ramsay score in the low-dose group was lower than that in the high-dose group at 15 minutes of anesthesia and 30 minutes of anesthesia(P<0.05).In both groups,the VAS scores of the high-dose group were lower than those in the low-dose group at 6,12 and 24 h after surgery,and the VAS score in both groups increased first and then decreased with time(P<0.05).1 day after surgery,the levels of hydrogen peroxide(H_(2)O_(2)),human cortisol(Cor)and malondialdehyde(MDA)in both groups were higher than those before surgery,and the levels of indexes in the low-dose group were lower than those in the high-dose group(P<0.05).15 minutes after anesthesia,diastolic blood pressure,systolic blood pressure and heart rate levels increased in both groups,oxygen saturation decreased in the high-dose group,and diastolic blood pressure,systolic blood pressure and heart rate in the low-dose group were lower than those in the high-dose group,and the oxygen saturation was higher than that in the high-dose group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Both doses of remazolam anesthesia have high anesthesia,sedation and analgesic effects,but high-dose anesthesia is easy to lead to large hemodynamic fluctuations and cause greater stress response in patients,so it is safer to use low-dose anesthesia for intrahepatic and extrahepatic bile duct stone surgery.
作者
史劲飞
汤洁
戴筱筱
孙登群
SHI Jin-fei;TANG Jie;DAI Xiao-xiao;SUN Deng-qun(Department of Anesthesiology,Anhui Armed Police Corps Hospital,Hefei 230001,Anhui,China;Department of General Surgery,Anhui Armed Police Corps Hospital,Hefei 230001,Anhui,China)
出处
《川北医学院学报》
2024年第1期30-33,50,共5页
Journal of North Sichuan Medical College
基金
安徽省自然科学基金(1908085MH261)。
关键词
瑞马唑仑
肝内外胆管结石
麻醉效果
血流动力学
Remazolam
Intrahepatic and extrahepatic bile duct stones
Anesthetic effect
Hemodynamics
作者简介
史劲飞(1979-),男,主治医师。E-mail:18055128555@163.com;通讯作者:孙登群,博士。Email:sundengqunsyl@126.com。
