瑞马唑仑与七氟烷在小儿扁桃体腺样体日间手术全身麻醉中的疗效比较

Comparison of clinical effects of remimazolam and sevoflurane in daytime adenotonsillectomy under general anesthesia in children

摘要:

目的 探讨瑞马唑仑与七氟烷在小儿扁桃体腺样体日间手术全身麻醉中的临床效果。方法 选取2023年7月—2025年6月在西安市儿童医院接受扁桃体腺样体日间手术的150例患儿为研究对象，随机分为实验组与对照组，各75例。实验组接受瑞马唑仑麻醉维持，对照组接受七氟烷麻醉维持。比较两组手术麻醉相关指标（自主呼吸恢复时间、苏醒时间、拔管时间）、血流动力学［麻醉前（T₀）、插管时（T₁）、插管后5 min（T₂）、术后10 min（T₃）、拔管时（T₄）的收缩压（SBP）、舒张压（DBP）、心率（HR）及血氧饱和度（SpO₂）］、谵妄状况［儿童麻醉苏醒期谵妄（PAED）评分］，疼痛状况［改良加拿大东安大略儿童医院疼痛评分量表（m-CHEOPS）］、家长满意度、不良反应（呼吸抑制、气道梗阻、低血压、恶心呕吐、疼痛、呛咳）的差异。结果 实验组自主呼吸恢复时间、苏醒时间和拔管时间均短于对照组（P <0.05）。实验组与对照组在T₀、T₁、T₂、T₃、T₄时SBP、DBP、HR、SpO₂比较，结果 ①不同时间点SBP、DBP、HR、SpO₂比较，差异有统计学意义（P <0.05）。②实验组与对照组SBP、DBP、HR比较，差异有统计学意义（P <0.05），SpO?差异无统计学意义（P >0.05）。③两组SBP、DBP、HR变化趋势比较，差异有统计学意义（P <0.05），SpO?差异无统计学意义（P >0.05）。实验组与对照组拔管后5 min、10 min、20 min、出麻醉恢复室时的PAED、m-CHEOPS评分比较，结果 ①不同时间点PAED、m-CHEOPS评分比较，差异有统计学意义（P <0.05）。②实验组与对照组PAED评分比较，差异有统计学意义（P <0.05），m-CHEOPS评分差异无统计学意义（P >0.05）。③两组PAED评分变化趋势比较，差异有统计学意义（P <0.05），m-CHEOPS评分变化趋势差异无统计学意义（P >0.05）。实验组家长满意度高于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 瑞马唑仑用于小儿扁桃体腺样体日间手术全身麻醉，可加速自主呼吸恢复和拔管时间，维持血流动力学稳定，减少苏醒期谵妄，家长满意度高。瑞马唑仑协同镇痛效果与七氟烷相当，不良反应发生率无差异。

Abstract:

Objective To compare the clinical effects of remimazolam and sevoflurane in pediatric adenotonsillectomy performed as day surgery under general anesthesia.Methods A total of 150 children who underwent day-case tonsillectomy and adenoidectomy in our hospital from July 2023 to June 2025 were enrolled and randomly divided into an experimental group (n = 75) and a control group (n = 75). The experimental group received anesthesia maintenance with remimazolam, while the control group received anesthesia maintenance with sevoflurane. The two groups were compared in terms of anesthesia-related indicators, hemodynamic parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and peripheral capillary oxygen saturation (SpO₂) at pre-anesthesia (T₀), intubation (T₁), 5 min after intubation (T₂), 10 min after surgery (T₃), and extubation (T₄) ], delirium status [Pediatric Anesthesia Emergence Delirium Scale (PAED) score], pain status [Modified Children's Hospital of Eastern Ontario Pain Scale (m-CHEOPS) ], parental satisfaction, and adverse events (respiratory depression, airway obstruction, hypotension, nausea and vomiting, pain, coughing).Results The recovery time of spontaneous respiration, awakening time, and extubation time were all shorter in the experimental group compared with the control group (P < 0.05). Differences in SBP, DBP, HR, and SpO₂ at various time points were statistically significant (P < 0.05). At T₁ and T₄, SBP, DBP, and HR were lower in the experimental group than in the control group (P < 0.05), while SpO₂ showed no significant difference between the two groups (P > 0.05). The overall trends in SBP, DBP, and HR differed significantly between groups (P < 0.05), but the trends in SpO₂ did not (P > 0.05). Differences in PAED and m-CHEOPS scores at various time points were statistically significant (P < 0.05). The experimental group had lower PAED scores at 5, 10, and 20 minutes after extubation and upon discharge from the post-anesthesia care unit (PACU) than the control group (P < 0.05), while m-CHEOPS scores showed no significant difference between groups (P > 0.05). The trends in PAED scores differed significantly between groups (P < 0.05), but the trends in m-CHEOPS scores did not (P > 0.05). Parental satisfaction was higher in the experimental group than in the control group (P < 0.05). The overall incidence of adverse reactions did not differ significantly between the two groups (P > 0.05).Conclusion The use of remimazolam for general anesthesia in pediatric tonsillectomy and adenoidectomy day surgery can accelerate the recovery of spontaneous respiration and shorten extubation time, maintain hemodynamic stability, reduce the incidence of emergence delirium, and achieve high parental satisfaction. The analgesic efficacy of remimazolam is comparable to that of sevoflurane, with no significant difference in the incidence of adverse reactions.