目的 评价瑞马唑仑用于全身麻醉对腹腔镜结直肠癌根治术患者细胞免疫功能及术后恢复质量的影响.方法 选择择期腹腔镜结直肠癌根治术患者60 例,男36 例,女24 例,年龄18～80 岁,BMI 18.5～28.0 kg/m2,ASA Ⅰ或Ⅱ级.按照随机数字将患者分为两组:瑞马唑仑组(R组)和丙泊酚组(P组),每组 30 例.麻醉诱导:R组静脉注射瑞马唑仑 0.2～0.3 mg/kg,推注时间大于 1 min,P组静脉注射丙泊酚 1.0～2.0 mg/kg,待患者意识消失即MOAA/S评分为 1～2 分后,两组静脉注射舒芬太尼 0.3～0.5 μg/kg和顺式阿曲库铵 0.15～0.2 mg/kg完成气管插管.麻醉维持:R组静脉泵注瑞马唑仑 1.0～2.0 mg·kg-1·h-1,P组静脉泵注丙泊酚 4.0～12.0 mg·kg-1·h-1,两组协同静脉泵注瑞芬太尼 0.1～0.2 μg·kg-1·min-1,间断静脉注射顺式阿曲库铵,术中维持BIS 40～60.记录麻醉诱导前、术毕即刻、术后 24、72 h T 细胞亚群 CD3+、CD4+、CD8+和 NK 细胞,并计算CD4+/CD8+,记录麻醉诱导前、插管即刻、切皮即刻、术毕即刻、拔管即刻的HR、MAP、SpO2、BIS,术中心血管不良事件发生率和血管活性药物使用率.记录麻醉诱导前、术后 24、72 h 15 项恢复质量(QoR-15)量表评分,苏醒时Riker评分和Ramsay评分,苏醒时间、拔管时间、PACU停留时间、术后首次肛门排气时间、术后住院时间和术后24h内恶心呕吐、嗜睡的发生率.结果 与P组比较,R组术毕即刻、术后 24 h NK、CD3+、CD4+细胞明显升高(P＜0.05),术毕即刻HR明显增快、MAP 明显升高(P＜0.05),术中低血压、心动过缓发生率和血管活性药物使用率明显降低(P＜0.05),术后 24、72 h QoR-15 评分明显升高(P＜0.05).两组苏醒时Riker评分和Ramsay评分差异无统计学意义.结论 与丙泊酚比较,瑞马唑仑全身麻醉对腹腔镜结直肠癌根治术患者围术期免疫功能影响更小,术中低血压、心动过缓发生率更低,术后恢复质量更高.
Effect of remimazolam on cellular immune function and quality of postoperative recovery in patients undergoing laparoscopic radical surgery for colorectal cancer
Objective To evaluate the effect of remimazolam for general anesthesia on cellular im-mune function and quality of postoperative recovery in patients undergoing laparoscopic radical surgery for colorectal cancer.Methods Sixty patients undergoing laparoscopic radical surgery for colorectal cancer,36 males and 24 females,aged 18-80 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were en-rolled in this study.The patients were divided into remimazolam group(group R)and propofol group(group P)by using a random number,with 30 patients in each group.Induction of anesthesia was as follows:remimazolam at a dose of 0.2-0.3 mg/kg was intravenously infused(intravenous injection time>1 minute)in group R,propofol at a dose of 1.0-2.0 mg/kg was intravenously infused in group P,and sufen-tanil at a dose of 0.3-0.5 μg/kg and cisatracurium at a dose of 0.15-0.2 mg/kg were intravenously in-fused injected after the patients consciousness disappeared,that is the modified observer's assessment of alertness/sedation score of 1-2 in two groups to complete tracheal intubation.Anesthesia maintenance was as follows:remimazolam at a dose of 1.0-2.0 mg·kg-1·h-1 was intravenously infused in group R,propo-fol at a dose of 4.0-12.0 mg·kg-1·h-1 was intravenously infused in group P,remifentanil at a dose of 0.1-0.2 μg·kg-1·min-1 was intravenously infused in two groups,and intravenous cisatracurium was in-jected intermittently to maintain the BIS value at 40-60 intraoperatively.The two groups percentage of CD3+,CD4+,CD8+T lymphocytes,natural killer cell and CD4+/CD8+ratio were collected before induction of anesthesia,at immediately after the end of the surgery,and 24,72 hours after surgery.The HR,MAP,percutaneous oxygen saturation,and bispectral index were collected before induction of anesthesia,immedi-ately after endotracheal intubation,immediately after surgical incision,immediately after endotracheal extu-bation.The incidence of intraoperative adverse cardiovascular events and utilization rate of vasoactive drugs were collected.The quality of recovery-15(QoR-15)scores before induction of anesthesia,and 24,72 hours after surgery were recorded.The Riker and Ramsay scores at awakening,emergence time,tracheal ex-tubation time,duration of post-anesthesia care unit(PACU)stay,first postoperative expiration time,and postoperative length of hospital stay were recorded.And the incidence of nausea,vomiting and sleepiness in the postoperative period of 24 hours were collected.Results Compared with group P,group R had signifi-cantly higher NK,CD3+,and CD4+cells immediately after the end of the surgery and 24 hours after surgery(P<0.05),significantly faster HR and higher MAP immediately after the end of the surgery(P<0.05),significantly lower incidence of intraoperative hypotension,bradycardia and the utilization rate of vasoactive drugs(P<0.05),and significantly higher QoR-15 scores 24,72 hours after surgery(P<0.05).There were no significant differences in the Riker and Ramsay scores between the two groups.Conclusion Com-pared with propofol,general anesthesia with remimazolam has less impact on the perioperative cellular im-mune function in patients undergoing laparoscopic radical surgery for colorectal cancer,with lower incidence of intraoperative hypotension and bradycardia,and higher quality of postoperative recovery.
RemimazolamRadical surgery of colorectal neoplasmsGeneral anesthesiaImmunity functionQuality of recovery
万方数据
维普
