不同负荷剂量苯磺酸瑞马唑仑复合舒芬太尼对妇科宫腔镜手术患者血流动力学的影响

Effects of different loading doses of remimazolam besylate combined with sufentanil on hemodynamics in patients undergoing hysteroscopic surgery

摘要:

目的 比较妇科宫腔镜手术麻醉应用不同负荷剂量苯磺酸瑞马唑仑复合舒芬太尼对患者血流动力学的影响。方法 选取2022年3月—2022年5月在南通大学附属妇幼保健院行妇科宫腔镜手术的患者120例，随机分为低、中、高剂量组，每组40例。所有患者采用舒芬太尼0.1 μg/kg进行镇痛预处理，低、中、高剂量组2 min后分别在10 min内匀速泵入苯磺酸瑞马唑仑0.10 mg/kg、0.15 mg/kg和0.20 mg/kg，然后静脉泵入苯磺酸瑞马唑仑0.05～0.5 mg/（kg·h）。比较3组手术时间、镇静有效率，进入手术室时（T₀）、扩张宫颈时（T₁）、宫内操作时（T₂）、手术结束时（T₃）心率（HR）、平均动脉压（MAP），以及3组麻醉药追加次数、苏醒时间、不良事件。结果 3组手术时间比较，差异无统计学意义（P >0.05）。中、高剂量组镇静有效率高于低剂量组（P <0.05）。低、中、高剂量组T₀、T₁、T₂、T₃时HR、MAP比较，采用重复测量设计的方差分析，结果 ①不同时间点HR、MAP有差异（F =85.415和47.562，均P =0.000）；②3组HR、MAP有差异（F =73.654和57.634，均P =0.000）；③3组HR、MAP变化趋势有差异（F =102.363和39.852，均P =0.000）。高剂量组T₁、T₂、T₃时HR、MAP低于低、中剂量组（P <0.05），3组T₁、T₂、T₃时HR、MAP低于T₀（P <0.05）。低剂量组麻醉药追加次数多于中、高剂量组（P <0.05），高剂量组苏醒时间长于低、中剂量组（P <0.05）。3组术中及术后均未发生严重不良事件。3组心动过缓、呼吸抑制、低氧血症、术中体动、术后下腹痛、术后头晕发生率比较，差异均无统计学意义（P >0.05）。结论 妇科宫腔镜手术麻醉0.15 mg/kg负荷剂量苯磺酸瑞马唑仑10 min泵入复合舒芬太尼可获取较好的镇静效果，且对血流动力学影响较小，安全性高。

Abstract:

Objective To compare the effects of different loading doses of remimazolam besylate combined with sufentanil on hemodynamics in patients undergoing hysteroscopic surgery.Methods A total of 120 patients who underwent hysteroscopic surgery in our hospital from March 2022 to May 2022 were selected and randomly divided into low-dose, medium-dose and high-dose groups, with 40 cases in each group. All patients received 0.1 μg/kg of sufentanil for analgesic pretreatment, and 0.10, 0.15 and 0.20 mg/kg of remimazolam besylate were pumped at a constant rate within 10 minutes into patients in the low-dose, medium-dose and high-dose groups, respectively. Afterwards, 0.05 to 0.50 mg/(kg·h) of remimazolam besylate was intravenously administrated. The operative duration and sedative efficacy among the three groups were compared. The heart rate (HR) and mean arterial pressure (MAP) at the time of admission into the operating room (T₀), at the time of cervical dilation (T₁), at the time of intrauterine operation (T₂), and at the end of the operation (T₃) among the three groups were compared. The number of additional drug administration, time of awakening, and adverse events among three groups were compared.Results There was no difference in the operative duration among the three groups (P > 0.05). The rate of effective sedation in the high-dose and medium-dose groups was higher than that in the low-dose group (P < 0.05). The comparison of HR and MAP at T₀, T₁, T₂, and T₃ in the low^-, medium^-, and high-dose groups was performed using repeated measures analysis of variance, and the results revealed that HR and MAP were different at different time points (F = 85.415 and 47.562, both P = 0.000) and that there were differences in HR and MAP among the three groups at T₁, T₂, and T₃ (F = 73.654 and 57.634, both P = 0.000). Besides, the change trends of HR and MAP were different among the three groups (F = 102.363 and 39.852, both P = 0.000). At T₁, T₂, and T₃, HR and MAP in the high-dose group were lower than those in the low- and medium-dose groups (P < 0.05). HR and MAP at T₁, T₂, and T₃ were lower than those at T0 in all three groups (P < 0.05). The number of additional drug administration in the low-dose group was higher than that in the medium-dose and high-dose groups (P < 0.05). The time of awakening in the high-dose group was longer than that in the low-dose and medium-dose group (P < 0.05). No severe adverse events occurred during and after the operation in the three groups. There was no significant difference in the incidence of bradycardia, respiratory depression, hypoxemia, intraoperative body movement, postoperative lower abdominal pain, and postoperative dizziness among the three groups (P > 0.05).Conclusions The infusion of remimazolam besylate at a loading dose of 0.15 mg/kg within 10 minutes combined with sufentanil for anesthesia in hysteroscopic surgery may achieve good sedative efficacy, with minor effects on hemodynamics and few safety concerns.