瑞马唑仑维持麻醉对Stanford B型主动脉夹层患者TEVAR术中血流动力学变化及麻醉相关不良反应的影响

Effects of maintenance anesthesia with remimazolam on hemodynamic changes and anesthesia-related adverse reactions during TEVAR in patients with Stanford type B aortic dissection

摘要:

目的 探讨瑞马唑仑维持麻醉对Stanford B型主动脉夹层患者胸主动脉腔内修复术（TEVAR）中血流动力学变化及麻醉相关不良反应的影响。方法 回顾性分析2022年6月—2025年6月于四川省妇幼保健院行TEVAR的212例Stanford B型主动脉夹层患者的临床资料，根据全程麻醉用药方案不同分为瑞马唑仑组（106例，瑞马唑仑诱导+维持麻醉）和丙泊酚组（106例，丙泊酚诱导+维持麻醉）。记录两组主要终点指标［心率波幅（ΔHR）和平均动脉压波幅（ΔMAP）］、次要终点指标［麻醉开始（T₀）、气管插管时（T₁）、气管插管后5 min（T₂）、手术结束时（T₃）、拔出气管导管时（T₄）及拔出气管导管后5 min（T₅）时平均动脉压（MAP）、心率（HR）、指端血氧饱和度（SpO₂）和双谱指数（BIS）值，以及住院时长、麻醉时间、术毕停药至气管导管拔出时间（手术间内拔管）及麻醉相关不良反应发生情况］。结果 瑞马唑仑组术毕停药至拔管时间短于丙泊酚组（P <0.05）。两组T₀～T₃时段HR、MAP比较，结果 ①不同时间点HR、MAP比较，差异均有统计学意义（P <0.05）；②两组HR、MAP比较，差异均有统计学意义（P <0.05）；③两组HR、MAP变化趋势比较，差异均有统计学意义（P <0.05）。两组T3～T5时段HR、MAP比较，结果 ①不同时间点HR、MAP比较，差异均有统计学意义（P <0.05）；②两组HR、MAP比较，差异均有统计学意义（P <0.05）；③两组HR、MAP变化趋势比较，差异均有统计学意义（P <0.05）。两组T₀～T₃时段SpO₂、BIS比较，结果 ①不同时间点SpO₂比较，差异无统计学意义（P >0.05），不同时间点BIS比较，差异有统计学意义（P <0.05）；②两组SpO₂、BIS比较，差异均有统计学意义（P <0.05）；③两组SpO₂变化趋势比较，差异无统计学意义（P >0.05），两组BIS变化趋势比较，差异有统计学意义（P <0.05）。两组T₃～T₅时段SpO₂、BIS比较，结果 ①不同时间点SpO₂、BIS比较，差异均有统计学意义（P <0.05）；②两组SpO₂、BIS比较，差异均有统计学意义（P <0.05）；③两组SpO₂、BIS变化趋势比较，差异均有统计学意义（P <0.05）。瑞马唑仑组注射疼痛率低于丙泊酚组（P <0.05）。结论 对于Stanford B型主动脉夹层行TEVAR术的患者，采用瑞马唑仑诱导+维持麻醉可提供更稳定的血流动力学，并有助于缩短拔管时间，降低注射痛发生率。

Abstract:

Objective To explore the effects of maintenance anesthesia with remimazolam on hemodynamic changes and anesthesia-related adverse reactions during thoracic endovascular aortic repair (TEVAR) in patients with Stanford type B aortic dissection.Methods A retrospective analysis was performed on the clinical data of 212 patients with Stanford type B aortic dissection who underwent TEVAR at the Sichuan Provincial Maternal and Child Health Hospital between June 2022 and June 2025. According to the anesthetic regimen used throughout the perioperative period, patients were divided into the remimazolam group (106 cases, anesthesia induced and maintained with remimazolam) and the propofol group (106 cases, anesthesia induced and maintained with propofol). The primary endpoints [heart rate fluctuation (ΔHR), mean arterial pressure fluctuation (ΔMAP) ] and secondary endpoints [mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO₂), and bispectral index (BIS) values at anesthesia induction (T₀), tracheal intubation (T₁), 5 min after tracheal intubation (T₂), the end of surgery (T₃), tracheal extubation (T₄), and 5 min after tracheal extubation (T₅), as well as length of hospital stay, duration of anesthesia, time from discontinuation of anesthetic agents to tracheal extubation (extubation performed in the operating room), and the incidence of anesthesia-related adverse events] were recorded in both groups.Results The time from discontinuation of anesthetic agents to tracheal extubation was shorter in the remimazolam group than in the propofol group (P < 0.05). Comparisons of HR and MAP between the two groups during the T₀-T₃ period showed that they were different across the time points (P < 0.05) and between the two groups (P < 0.05), and that the trends of HR and MAP changes over time differed significantly between the two groups (P < 0.05). Comparisons of HR and MAP during the T₃-T₅ period showed that they were different across the time points (P < 0.05) and between the two groups (P < 0.05), and that the trends of HR and MAP changes over time differed significantly between the two groups (P < 0.05). Comparisons of SpO₂ and BIS during the T₀-T₃ period showed that no significant difference was observed in SpO₂ across different time points (P > 0.05), whereas BIS differed significantly across time points (P < 0.05). Significant differences in SpO₂ and BIS were observed between the two groups (P < 0.05), and no significant difference was observed in the trend of SpO₂ changes between the two groups (P > 0.05), whereas the trend of BIS changes differed significantly between the two groups (P < 0.05). Comparisons of SpO₂ and BIS during the T₃-T₅ period showed that significant differences in SpO₂ and BIS were observed across different time points (P < 0.05) and between the two groups (P < 0.05), and that the trends of SpO₂ and BIS changes differed significantly between the two groups (P < 0.05). The incidence of injection pain was lower in the remimazolam group than in the propofol group (P < 0.05).Conclusion For patients with Stanford type B aortic dissection undergoing TEVAR, anesthesia induced and maintained with remimazolam provides more stable hemodynamics, helps shorten the time to tracheal extubation, and reduces the incidence of injection pain.