瑞马唑仑在肥胖患者腹腔镜胆囊切除术中的应用

Application of remimazolam in obese patients undergoing laparoscopic cholecystectomy

摘要:

目的 探讨瑞马唑仑在肥胖患者腹腔镜胆囊切除术中的应用。方法 选取2021年9月—2024年2月铜川市人民医院120例接受腹腔镜胆囊切除术的肥胖患者为研究对象，采用摸球法分组，奇数为对照组，偶数为观察组，每组60例。对照组予以丙泊酚麻醉诱导，观察组予以瑞马唑仑麻醉诱导，比较两组麻醉苏醒效果、不同时间点［麻醉诱导前（T₀）、插管即刻（T₁）、气腹即刻（T₂）、拔管即刻（T₃）］的血流动力学指标［平均动脉压（MAP）、心率（HR）］、术前及术后1 d的氧化应激指标［超氧化物歧化酶（SOD）、丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-Px）］、认知功能评分［简易精神状态评价量表（MMSE）］及不良反应发生情况。结果 观察组苏醒时间、拔管时间和麻醉恢复室（PACU）停留时间均短于对照组（P <0.05）。实验组与对照组不同时间点的MAP、HR水平比较，结果 ①不同时间点MAP、HR水平比较，差异有统计学意义（P <0.05）；②实验组与对照组MAP、HR水平比较，差异有统计学意义（P <0.05），实验组MAP、HR水平较高，相对血流动力学较稳定；③两组MAP、HR水平变化趋势比较，差异有统计学意义（P <0.05）。观察组术前与术后1 d的SOD、GSH-Px、MDA及MMSE评分的变化幅度均小于对照组（P <0.05）。观察组不良反应总发生率低于对照组（P <0.05）。结论 瑞马唑仑在肥胖患者腹腔镜胆囊切除术中能有效缩短苏醒时间和PACU停留时间，改善氧化应激指标及认知功能，且不良反应发生率较低。

Abstract:

Objective To investigate the application of remimazolam in obese patients undergoing laparoscopic cholecystectomy.Methods This study included 120 obese patients who underwent laparoscopic cholecystectomy at Tongchuan People's Hospital from September 2021 to February 2024. Patients were randomly assigned using a drawing method: odd-numbered patients to control group (n = 60) received propofol for anesthesia induction; even-numbered patients to observation group (n = 60) received remimazolam. The two groups were compared for anesthesia recovery outcomes, hemodynamic parameters at different time points [before induction of anesthesia (T₀), immediately after intubation (T₁), immediately after pneumoperitoneum (T₂), immediately after extubation (T₃)] [mean arterial pressure (MAP), heart rate (HR) ], oxidative stress indicators before surgery and on postoperative day 1 [superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-Px) ], cognitive function [Mini-Mental State Examination (MMSE) ], and incidence of adverse reactions.Results There were statistically significant differences between the two groups in awakening time, extubation time, and post-anesthesia care unit (PACU) stay, with shorter durations in the observation group (P < 0.05, t-test). Repeated measures ANOVA revealed that MAP and HR levels at T₀, T₁, T₂, and T₃ showed significant differences across time points (P < 0.05), between groups (P < 0.05), and in interaction trends (P < 0.05). The observation group maintained higher MAP and HR levels, indicating more stable hemodynamics. The changes in SOD, GSH-Px, and MDA levels from preoperative to postoperative day 1 were significantly smaller in the observation group (P < 0.05). Similarly, the change in MMSE score was smaller in the observation group, indicating better cognitive preservation. The total incidence of adverse reactions was significantly lower in the observation group compared to the control group (P < 0.05).Conclusion Remimazolam effectively shortens awakening time and PACU stay, improves oxidative stress indicators and cognitive function, and has a lower incidence of adverse reactions in obese patients undergoing laparoscopic cholecystectomy.