瑞马唑仑对腹腔镜卵巢囊肿切除术的麻醉效果及对认知功能和应激反应的影响

Anesthesia effects of remazolam on cognitive function and stress response in laparoscopic ovarian cystectomy

摘要:

目的 探讨瑞马唑仑对腹腔镜卵巢囊肿切除术的麻醉效果，以及对患者认知功能和应激反应的影响。方法 选取2021年1月—2022年12月于南通市妇幼保健院行腹腔镜卵巢囊肿切除术的患者102例，随机分为丙泊酚组和瑞马唑仑组，各51例。丙泊酚组采用丙泊酚麻醉诱导，静脉滴注瑞芬太尼、丙泊酚进行麻醉维持；瑞马唑仑组采用瑞马唑仑麻醉诱导，静脉滴注瑞芬太尼、瑞马唑仑进行麻醉维持。比较两组患者的手术时间及麻醉效果；比较两组患者围手术期血流动力学指标及应激指标；比较两组患者的术后认知功能及不良反应。结果 两组镇静成功率均为100%。丙泊酚组睫毛反射消失时间、麻醉趋势指数（NI）降至D₀（D₀为麻醉深度较浅，患者对外界刺激有反应，但无意识）的时间均短于瑞马唑仑组（P <0.05），苏醒时间长于瑞马唑仑组（P <0.05）。两组麻醉诱导后5 min、手术开始后30 min、手术结束时、拔管后5 min的平均动脉压（MAP）、氧饱和度（SaO₂）比较，经重复测量设计的方差分析，结果 ①不同时间点的MAP差异有统计学意义（P <0.05），SaO₂差异无统计学意义（P >0.05）；②两组的MAP差异有统计学意义（P <0.05），SaO₂差异无统计学意义（P >0.05）；③两组的MAP变化趋势差异有统计学意义（P <0.05），SaO₂变化趋势差异无统计学意义（P >0.05）。两组术前、手术结束时、术后48 h的血清促肾上腺皮质激素（ACTH）、醛固酮（ALD）水平比较，经重复测量设计的方差分析，结果 ①不同时间点的血清ACTH、ALD水平差异有统计学意义（P <0.05）；②两组的血清ACTH、ALD水平差异均无统计学意义（P >0.05）；③两组的血清ACTH、ALD水平变化趋势差异均无统计学意义（P >0.05）。丙泊酚组患者的术后认知功能障碍、注射痛、呼吸抑制发生率均高于瑞马唑仑组（P <0.05）。结论 相较于丙泊酚，瑞马唑仑在腹腔镜卵巢囊肿切除术中起效较慢，但对血流动力学、认知功能影响较小，降低注射痛、呼吸抑制，两者应激反应相当。

Abstract:

Objective To investigate the anesthetic effect of remimazolam on laparoscopic ovarian cystectomy and its impact on patients' cognitive function and stress response.Methods A total of 102 patients undergoing laparoscopic ovarian cystectomy at Nantong Maternal and Child Health Hospital from January 2021 to December 2022 were randomly divided into two groups: the propofol group and the remimazolam group, with 51 patients in each group. The propofol group received propofol anesthesia induction and intravenous infusion of remifentanil and propofol for anesthesia maintenance, while the remimazolam group received remimazolam anesthesia induction and intravenous infusion of remifentanil and remimazolam for anesthesia maintenance. The surgical time and anesthetic effect were compared between the two groups. Hemodynamic parameters and stress indicators during the perioperative period were compared between the two groups. Postoperative cognitive function and adverse reactions were compared between the two groups.Results The sedation success rate was 100% in both groups. The time to disappearance of eyelash reflex and the time for the anesthetic trend index (NI) to decrease to D₀ (D₀ indicates a shallow depth of anesthesia, with patients responding to external stimuli but without consciousness) were shorter in the propofol group than in the remimazolam group (P < 0.05), while the time to awakening was longer in the propofol group than in the remimazolam group (P < 0.05). The average arterial pressure (MAP) and oxygen saturation (SaO₂) at 5 minutes after anesthesia induction, 30 minutes after the start of surgery, at the end of surgery, and 5 minutes after extubation were compared between the two groups. The results of repeated measures analysis of variance showed: 1. The differences in MAP at different time points were statistically significant (P < 0.05), while the differences in SaO₂ were not statistically significant (P > 0.05). 2. The differences in MAP between the two groups were statistically significant (P < 0.05), while the differences in SaO₂ were not statistically significant (P > 0.05). 3. The differences in the trends of MAP changes between the two groups were statistically significant (P < 0.05), while the differences in the trends of SaO₂ changes were not statistically significant (P > 0.05). The serum adrenocorticotropic hormone (ACTH) and aldosterone (ALD) levels before surgery, at the end of surgery, and 48 hours after surgery were compared between the two groups. The results of repeated measures analysis of variance showed: 1. The differences in serum ACTH and ALD levels at different time points were statistically significant (P < 0.05). 2. There were no statistically significant differences in serum ACTH and ALD levels between the two groups (P > 0.05). 3. There were no statistically significant differences in the trends of serum ACTH and ALD levels between the two groups (P > 0.05). The incidence of postoperative cognitive dysfunction, injection pain, and respiratory depression in the propofol group was higher than that in the remimazolam group (P < 0.05).Conclusion Compared with propofol, remimazolam has a slower onset of action in laparoscopic ovarian cystectomy, but has less impact on hemodynamics and cognitive function, reduces injection pain and respiratory depression, and has comparable stress responses between the two groups.