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| 瑞马唑仑和丙泊酚用于肝硬化患者内镜下静脉曲张套扎术的比较 |
| Comparison of the effect of remimazolam tosilate and propofol for general anesthesia in cirrhotic patients undergoing endoscopic variceal ligation |
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| DOI：10.12089/jca.2023.01.009 |
| 中文关键词: 瑞马唑仑 丙泊酚 内镜下静脉曲张套扎术 肝硬化 |
| 英文关键词: Remimazolam Propofol Endoscopic varicose ligation Liver cirrhosis |
| 基金项目:青海省卫生健康委指导性计划课题（2021-wjzdx-59）；青海大学附属医院中青年科研基金项目（ASRF-2021-YB-03） |
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| 中文摘要: |
目的 探讨瑞马唑仑和丙泊酚对肝硬化患者内镜下静脉曲张套扎术血流动力学和不良反应的影响。
方法 纳入拟行内镜下静脉曲张套扎术的肝硬化患者96例，男43例，女53例，年龄18～70岁，BMI 18.5～27.9 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：瑞马唑仑组（R组）和丙泊酚组（P组），每组48例。R组静脉注射瑞马唑仑0.2 mg/kg行麻醉诱导，静脉泵注瑞马唑仑1～2 mg·kg-1·h-1行麻醉维持；P组静脉注射丙泊酚2 mg/kg行麻醉诱导，静脉泵注丙泊酚4～10 mg·kg-1·h-1行麻醉维持。记录麻醉诱导前（T0）、麻醉诱导后（T1）、气管插管后（T2）、手术开始后5 min（T3）、拔管后（T4）的HR和MAP。记录患者意识消失时间、拔管时间、意识恢复时间、PACU停留时间。记录术前、术后1 d谷氨酸-丙酮酸转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）。记录术中低血压、术后低氧血症、头晕、恶心呕吐、苏醒延迟、苏醒期躁动的发生情况。
结果 与P组比较，R组T1—T3时HR、MAP明显升高（P＜0.05），意识消失时间明显延长（P＜0.05），拔管时间、意识恢复时间和PACU停留时间明显缩短（P＜0.05），术中低血压、术后低氧血症发生率明显降低（P＜0.05）。两组T0、T4时HR、MAP差异无统计学意义。两组术后1 d ALT、AST和头晕、恶心呕吐、苏醒延迟、苏醒期躁动发生率差异均无统计学意义。
结论 与丙泊酚比较，瑞马唑仑对行内镜下静脉曲张套扎术肝硬化患者的血流动力学影响较小，可明显降低低血压发生率，安全性较高。 |
| 英文摘要: |
Objective To compare remimazolam and propofol on hemodynamics and adverse reaction in patients with cirrhosis.
Methods Ninety-six patients, 43 males and 53 females, aged 18-70 years, BMI 18.5-27.9 kg/m2, ASA physical status Ⅱ or Ⅲ, with cirrhosis who were scheduled to receive endoscopic variceal ligation were included. Patients were randomly assigned into two groups: remimazolam group (group R) and propofol group (group P), 48 patients in each group. Group R received intravenous injection of remazolam 0.2 mg/kg for anesthesia induction, and intravenous pump injection of remazolam 1-2 μg·kg-1·min-1 for anesthesia maintenance. In group P, propofol 2 mg/kg was injected intravenously to induce anesthesia, and propofol 4-10 μg·kg-1·min-1 was injected intravenously to maintain anesthesia. HR and MAP were recorded before induction of anesthesia (T0), after induction of anesthesia (T1), after endotracheal intubation (T2), 5 minutes after operation (T3) and after extubation (T4). The time of consciousness disappearance, extubation time, consciousness recovery time and PACU retention time were recorded. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected before surgery and 1 day after surgery. The incidence rates of intraoperative hypotension, postoperative hypoxemia, dizziness, nausea and vomiting, delayed recovery and agitation during recovery were recorded.
Results Compared with group P, HR and MAP in group R were significantly increased at T1-T3(P < 0.05), the time of consciousness disappearance was significantly longer (P < 0.05), the extubation time, consciousness recovery time and PACU residence time of patients in group R were significantly shorter (P < 0.05), the incidence of intraoperative hypotension and postoperative hypoxemia in group R were significantly lower (P < 0.05). There were no significant differences in HR and MAP at T0 and T4 between the two groups. There were no significant difference in ALT and AST between the two groups at 1 day after operation. There were no significant differences in dizziness, nausea and vomiting, delay in awakening and agitation during awakening between the two groups.
Conclusion Compared with propofol, remazolam has less effect on hemodynamics in patients with cirrhosis undergoing endoscopic variceal ligation, and can significantly reduce the incidence of hypotension with higher safety. |
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