目的:探讨甲苯磺酸瑞马唑仑联合依托咪酯在颅脑手术中应用价值.方法:依据配对原则回顾性选取 2021年 11 月至 2023 年 11 月在我院接受颅脑手术治疗的患者 112 例,按麻醉方案不同分为对照组(n=56)、观察组(n=56).其中采用依托咪酯麻醉的纳入对照组,采用甲苯磺酸瑞马唑仑联合依托咪酯麻醉的纳入观察组.比较两组不同时间点[术前(T0)、诱导后 5 min(T1)、插管即刻时(T2)、术毕时(T3)]平均动脉压、心率水平,麻醉相关指标[意识消失时间、自主呼吸恢复时间、麻醉苏醒时间].以T0、术后 1 d为时间节点,比较两组神经功能指标[神经元特异性烯醇化酶(Neuron-specific-enolase,NSE)、中枢神经特异蛋白(Central nervous system specific protein,S100β)、胶质纤维酸性蛋白(Glial fibrillary acidic protein,GFAP)]、血清炎症因子指标[超敏 C 反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、白细胞介素-1β(Interleukin-1β,IL-1β)]水平及不良反应总发生率.结果:观察组T1～T3 时心率、平均动脉压水平波动幅度小于对照组(P＜0.05);观察组意识消失时间、自主呼吸恢复时间、麻醉苏醒时间短于对照组(P＜0.05);观察组术后 1 d S100β、GFAP、NSE水平、hs-CRP、IL-1β水平低于对照组(P＜0.05);观察组不良反应总发生率(8.93%)与对照组(7.14%)比较,差异无统计学意义(P＞0.05).结论:甲苯磺酸瑞马唑仑、依托咪酯复合麻醉能有效维持颅脑手术患者循环稳定,减轻炎症反应,减少神经功能损伤,且易唤醒,麻醉安全性有保障.
Effects of Remazolam toluenesulfonate combined with Etomidate on neurological function and serum inflammatory factors in patients undergoing craniocerebral surgery
Objective:To investigate the application value of remazolam toluenesulfonate combined with etomidate in craniocerebral surgery.Methods:One hundred and twelve patients who underwent craniocerebral surgery treatment in our hospital from November 2021 to November 2023 were retrospectively selected based on the principle of matching,and were divided into the control group(n=56)and the observation group(n=56)according to the difference in anesthesia protocols.The patients who were anesthetized with etomidate were included in the control group,and the patients who were anesthetized with remazolam toluenesulfonate combined with etomidate were included in the observation group.The mean arterial pressure,heart rate,anesthesia related indexes[time of consciousness disappearance,time of spontaneous breathing recovery,time of anesthesia recovery]were compared between the two groups at different time points[before operation(T0),5 minutes after induction(T1),immediately after intubation(T2),and at the end of operation(T3)].Taking T0 and 1 day after operation as time nodes,the levels of neurological function indexes[neuron specific enolase(NSE),central nervous system specific protein(S100β),glial fibrillary acidic protein(GFAP)],serum inflammatory factor indexes[hypersensitive C-reactive protein(hs-CRP),interleukin-1β(IL-1β)]were compared between the two groups.The total incidence of adverse reactions was also compared between the two groups.Results:The fluctuation amplitude of heart rate and mean arterial pressure at T1～T3 in the observation group were less than those in the control group(P<0.05);the consciousness disappearance time,spontaneous breathing recovery time and anesthesia recovery time in the observation group were shorter than those in the control group(P<0.05);one day after operation,the levels of S100β,GFAP,NSE,hs-CRP and IL-1β in the observation group were lower than those in the control group(P<0.05);there was no significant difference in the total incidence of adverse reactions between the observation group(8.93%)and the control group(7.14%)(P>0.05).Conclusion:Remimazolam toluenesulfonate and etomidate combined anesthesia can effectively maintain the circulation stability of patients with craniocerebral surgery,reduce inflammatory reaction,reduce nerve function injury,and is easy to wake up,and the anesthesia safety is guaranteed.
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