摘要
目的 观察瑞马唑仑、环泊酚及丙泊酚用于全麻诱导时对患者血流动力学及血糖和乳酸的影响.方法 选择2023年8月至11月南京医科大学第二附属医院全麻下行非心胸外科及神经外科的择期手术患者126例.依据随机数字表法,将患者分为瑞马唑仑组、环泊酚组和丙泊酚组,每组42例.全麻诱导(静脉注射舒芬太尼0.2～0.3 μg/kg)后,三组分别注射研究药物:瑞马唑仑组静脉注射瑞马唑仑0.3 mg/kg,环泊酚组静脉注射环泊酚0.4 mg/kg(70岁以上为0.3 mg/kg),丙泊酚组静脉注射丙泊酚2.0 mg/kg(70岁以上为1.5 mg/kg).待患者睫毛反射消失,注射罗库溴铵0.6 mg/kg,3 min后置入喉罩,行呼吸控制.记录患者入室后(T0)、插管前(T1)、插管后即刻(T2)、插管后3 min(T3)的心率(HR)、平均动脉压(MAP)及脑电双频指数(BIS)值;记录T,、T3的血糖及乳酸值;记录诱导期注射痛、低血压、低心率、呃逆、苏醒期躁动等发生情况;记录出复苏室时患者满意度及有无术中知晓、头晕、恶心呕吐等不良反应.结果 最终纳入瑞马唑仑组42例、环泊酚组36例、丙泊酚组39例.诱导期低血压发生情况为瑞马唑仑组9例(21％),环泊酚组15例(42％),丙泊酚组21例(54％),三组间差异有统计学意义(x2=9.204,P=0.010),且瑞马唑仑组低血压发生率显著低于丙泊酚组(P＜0.017).诱导期低心率瑞马唑仑组6例(14％),环泊酚组18例(50％),丙泊酚组12例(31％),三组间差异有统计学意义(x2=11.607,P=0.003),且瑞马唑仑组低心率发生率显著低于环泊酚组(P＜0.017).多因素分析结果显示瑞马唑仑是诱导期低血压(OR=1.199,95％C/:0.073～0.549,P=0.002)和低心率(OR=0.173,95％CI:0.057～0.520,P=0.002)的独立保护因素.瑞马唑仑组、环泊酚组和丙泊酚组注射痛发生率差异有统计学意义(14％vs 0 vs 54％,x2=33.429,P＜0.001).结论 瑞马唑仑、环泊酚及丙泊酚均可用于麻醉诱导.丙泊酚低血压作用显著,环泊酚低心率作用明显,瑞马唑仑是诱导期低血压和低心率的独立性保护因素.
Abstract
Objective To observe the effects of remimazolam,cipepofol,and propofol on hemodynamics,blood glucose,and lactate levels during general anesthesia induction.Methods A total of 126 elective surgery patients at the Second Affiliated Hospital of Nanjing Medical University from August to November 2023,undergoing non-cardiothoracic and neurosurgical procedures under general anesthesia,were included.Patients were randomly assigned using a random number table into three groups:remimazolam group,cipepofol group,and propofol group,with 42 patients in each group.Anesthesia induction included intravenous sufentanil 0.2-0.3 μg/kg followed by administration of the study drugs:remimazolam group received remimazolam 0.3 mg/kg,cipepofol group received cipepofol 0.4 mg/kg(0.3 mg/kg for patients over 70 years),and propofol group received propofol 2.0 mg/kg(1.5 mg/kg for patients over 70 years).Rocuronium 0.6 mg/kg was injected after loss of eyelash reflex,followed by placement of a laryngeal mask for ventilation control.Heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)values were recorded at upon entry(T0),before intubation(T,),immediately after intubation(T2),and 3 minutes after intubation(T3).Blood glucose and lactate levels were recorded at T1 and T3.Incidence of injection pain,hypotension,bradycardia,hiccup,agitation during emergence,patient satisfaction upon leaving the recovery room,intraoperative awareness,postoperative dizziness,nausea,and vomiting were also documented.Results A total of 42 cases were included in the remimazolam group,36 cases in the cipepofol group,and 39 cases in the propofol group.The incidence of hypotension during induction was 9 cases(21％)in the remimazolam group,15 cases(42％)in the cipepofol group,and 21 cases(54％)in the propofol group,and the difference among three groups was significant(x2=9.204,P=0.010).The remimazolam group had a significantly lower incidence of hypotension compared to the propofol group(P＜0.017).Bradycardia during induction occurred in 6 cases(14％)in the remimazolam group,18 cases(50％)in the cipepofol group,and 12 cases(31％)in the propofol group,with significant difference among three groups(x2=11.607,P=0.003).The remimazolam group had a significantly lower incidence of bradycardia compared to the cipepofol group(P＜0.017).Multivariate analysis indicated that the remimazolam was an independent protective factor against hypotension(OR=0.199,95％CI:0.073-0.549,P=0.002)and bradycardia(OR=0.173,95％CI:0.057-0.520,P=0.002)during induction.There was statistically significant difference in the incidence of injection pain among the remimazolam group,cipepofol group,and propofol group(14％vs 0 vs 54％,x2=33.429,P＜0.001).Conclusion Remimazolam,cipepofol,and propofol can be used for anesthesia induction.Propofol could induce hypotension,while propofol notably induces bradycardia.Remimazolam acts as an independent protective factor against hypotension and bradycardia during induction.
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