甲苯磺酸瑞马唑仑对老年全身麻醉诱导期血流动力学的影响

杜晨; 田刚

doi:10.11659/jjssx.01E023105

您当前的位置：

首页 >

文章列表页 >

甲苯磺酸瑞马唑仑对老年全身麻醉诱导期血流动力学的影响

临床研究 | 更新时间：2024-02-02

- 甲苯磺酸瑞马唑仑对老年全身麻醉诱导期血流动力学的影响
- Effect of remimazolam tosylate on hemodynamics during the induction of general anesthesia in the elderly
- 局解手术学杂志 2024年33卷第2期页码：140-144
- 作者机构：
  
  十堰市人民医院/湖北医药学院附属人民医院麻醉手术中心，湖北十堰 442000
- 作者简介：
  
  田刚，E-mail：tiangang771020@aliyun.com
- 基金信息：
- DOI：10.11659/jjssx.01E023105
  中图分类号： R614
- 纸质出版日期：2024-02-25，
  
  收稿日期：2023-01-31，
扫描看全文
杜晨,田刚.甲苯磺酸瑞马唑仑对老年全身麻醉诱导期血流动力学的影响[J].局解手术学杂志,2024,33(02):140-144.

DU Chen,TIAN Gang.Effect of remimazolam tosylate on hemodynamics during the induction of general anesthesia in the elderly[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(02):140-144.
杜晨,田刚.甲苯磺酸瑞马唑仑对老年全身麻醉诱导期血流动力学的影响[J].局解手术学杂志,2024,33(02):140-144. DOI： 10.11659/jjssx.01E023105.

DU Chen,TIAN Gang.Effect of remimazolam tosylate on hemodynamics during the induction of general anesthesia in the elderly[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2024,33(02):140-144. DOI： 10.11659/jjssx.01E023105.

摘要

目的

探讨甲苯磺酸瑞马唑仑对老年患者全身麻醉诱导期血流动力学的影响。

方法

选择于我院行气管插管全身麻醉的非心脏手术老年患者90例，随机均分为甲苯磺酸瑞马唑仑组（R组）和依托咪酯组（E组）。麻醉诱导时，给予R组患者甲苯磺酸瑞马唑仑0.3 mg/kg，给予E组患者依托咪酯0.3 mg/kg。比较2组患者麻醉诱导前（T0）、诱导完成即刻（T1）、气管插管后（T2）的心率（HR）、平均动脉压（MAP）、脑电双频指数（BIS）。统计2组患者诱导时间、拔管时间、拔管后5 min时的Ramsay镇静评分、出麻醉后恢复室（PACU）时间、手术时间、麻醉时间及不良反应发生率。

结果

2组患者T0时MAP、HR、BIS比较，差异均无统计学意义（

0.05）；R组患者T1、T2时MAP高于E组患者（

0.05），T2时HR低于E组患者（

0.05）；与T0时比较，R组患者T1、T2时的HR、MAP和BIS均降低，E组患者T1、T2时MAP和BIS均降低，T1时HR下降，T2时HR升高，差异均有统计学意义（

0.05）。R组患者诱导时间及拔管时间短于E组患者（

0.05）。2组患者Ramsay镇静评分、出PACU时间、手术时间、麻醉时间比较，差异均无统计学意义（

0.05）。E组肌阵挛和低血压的发生率高于R组，不良反应总发生率高于R组，差异均有统计学意义（

0.05）。

结论

相较于依托咪酯，甲苯磺酸瑞马唑仑用于老年患者全身麻醉诱导血流动力学更稳定，不良反应更少。

Abstract

Objective

To investigate the effect of rimimazolam tosylate on hemodynamics during the induction of general anesthesia in elderly patients.

Methods

A total of 90 elderly patients who received non-cardiac surgery under tracheal intubation general anesthesia in our hospital were selected，and randomly divided into the remimazolam tosylate group （group R） and the etomidate group （group E）.During anesthesia induction，patients in the group R were given 0.3 mg/kg of remimazolam tosylate，and patients in the group E were given 0.3 mg/kg of etomidate. The heart rate （HR），mean arterial pressure （MAP），and bispectral index （BIS） before the induction of anesthesia （T0），after the induction of anesthesia （T1），and after tracheal intubation （T2）of patients in the two groups were compared. The induction time，extubation time，Ramsay sedation score 5 minutes after extubation，time out of the postanesthesia care unit （PACU），operation time，anesthesia time and incidence of adverse reactions in the two groups were counted.

Results

There was no significant difference in the MAP，HR or BIS of patients at T0 between the two groups （

0.05）； the MAP of patients at T1 and T2 in the group R were higher than those in the group E （

0.05），and the HR of patients at T2 was lower than that in the group E （

0.05）. Compared with T0，the HR，MAP and BIS of patients at T1 and T2 in the group R were decreased；the MAP and BIS of patients at T1 and T2 in the group E were decreased，HR of patients was decreased at T1 and increased at T2，with statistically significant differences（

0.05）. The induction time and extubation time of patients in the group R were shorter than those in the group E （

0.05）. There was no significant difference in the Ramsay sedation score，time out of the PACU，operation time oranesthesia time of patients between the two groups （

0.05）. The incidences of myoclonus and hypotension of patients in the group E were higher than those in the group R，and the total incidence of adverse reactions in the group E was higher than that in the group R，with statistically significant differences （

0.05）.

Conclusion

Compared to etomidate，remazolam tosylate is more stable in inducing hemodynamics and has fewer adverse reactions in elderly patients under general anesthesia.

关键词

甲苯磺酸瑞马唑仑依托咪酯老年患者麻醉诱导血流动力学

Keywords

rimimazolam tosylateetomidateelderly patientsanesthesia inductionhemodynamics

references

Sudfeld S，Brechnitz S，Wagner JY，et al.Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia［J］.Br J Anaesth，2017，119（1）：57-64.doi：10.1093/bja/aex127http://dx.doi.org/10.1093/bja/aex127.

Schuttler J，Eisenried A，Lerch M，et al.Pharmacokinetics and pharmacodynamics of remimazolam （CNS 7056） after continuous infusion in healthy male volunteers：part Ⅰ.Pharmacokinetics and clinical pharmacodynamics［J］.Anesthesiology，2020，132（4）：636-651.doi：10.1097/ALN.0000000000003103http://dx.doi.org/10.1097/ALN.0000000000003103.

Pesic M，Schippers F，Saunders R，et al.Pharmacokinetics and pharmacodynamics of intranasal remimazolam-a randomized controlled clinical trial［J］.Eur J Clin Pharmacol，2020，76（11）：1505-1516.doi：10.1007/s00228-020-02984-zhttp://dx.doi.org/10.1007/s00228-020-02984-z.

Nieman CL，Pitman KT，Tufaro AP，et al.The effect of frailty on short-term outcomes after head and neck cancer surgery［J］.Laryngoscope，2018，128（1）：102-110.doi：10.1002/lary.26735http://dx.doi.org/10.1002/lary.26735.

Kim JM，Shin TG，Hwang SY，et al.Sedative dose and patient variable impacts on postintubation hypotension in emergency airway management［J］.Am J Emerg Med，2019，37（7）：1248-1253.doi：10.1016/j.ajem.2018.09.015http://dx.doi.org/10.1016/j.ajem.2018.09.015.

刘红辉，邓芳文，孙德贵，等.预注布托啡诺预防依托咪酯所致肌阵挛效果的Meta分析［J］.临床医药实践，2021，30（1）：11-16.

Kunkel S，Lenz T.Hemodynamics in helicopter emergency medical services （HEMS） patients undergoing rapid sequence intubation with etomidate or ketamine［J］.J Emerg Med，2022，62（2）：163-170.doi：10.1016/j.jemermed.2021.10.004http://dx.doi.org/10.1016/j.jemermed.2021.10.004.

Wesolowski AM，Zaccagnino MP，Malapero RJ，et al.Remimazolam：pharmacologic considerations and clinical role in anesthesiology［J］.Pharmacotherapy，2016，36（9）：1021-1027.doi：10.1002/phar.1806http://dx.doi.org/10.1002/phar.1806.

Jacob TC，Moss SJ，Jurd R.GABA（A） receptor trafficking and its role in the dynamic modulation of neuronal inhibition［J］.Nat Rev Neurosci，2008，9（5）：331-343.doi：10.1038/nrn2370http://dx.doi.org/10.1038/nrn2370.

Sneyd JR.Remimazolam：new beginnings or just a me-too？［J］.Anesth Analg，2012，115（2）：217-219.doi：10.1213/ANE.0b013e31823acb95http://dx.doi.org/10.1213/ANE.0b013e31823acb95.

Doi M，Morita K，Takeda J，et al.Efficacy and safety of remimazolam versus propofol for general anesthesia：amulticenter，single-blind，randomized，parallel-group，phase Ⅱb/Ⅲ trial［J］.J Anesth，2020，34（4）：543-553.doi：10.1007/s00540-020-02788-6http://dx.doi.org/10.1007/s00540-020-02788-6.

Doi M，Hirata N，Suzuki T，et al.Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients （ASA class Ⅲ）：results of a multicenter，randomized，double-blind，parallel-group comparative trial［J］.J Anesth，2020，34（4）：491-501.doi：10.1007/s00540-020-02776-whttp://dx.doi.org/10.1007/s00540-020-02776-w.

Morimoto Y，Yoshimatsu A，Yoshimura M.Anesthetic management for a patient with myotonic dystrophy with remimazolam［J］.JA Clin Rep，2021，7（1）：10-13.doi：10.1186/s40981-021-00413-3http://dx.doi.org/10.1186/s40981-021-00413-3.

Yoshida A，Kurata S，Kida K，et al.Anesthetic management for the sleep-awake-sleep technique of awake craniotomy using a novel benzodiazepine remimazolam and its antagonist flumazenil［J］.JA Clin Rep，2021，7（1）：14-17.doi：10.1186/s40981-021-00417-zhttp://dx.doi.org/10.1186/s40981-021-00417-z.

Saito K，Ohno S，Maeda M，et al.Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass：a case report［J］.JA Clin Rep，2021，7（1）：21-25.doi：10.1186/s40981-021-00424-0http://dx.doi.org/10.1186/s40981-021-00424-0.

Liu T，Lai T，Chen J，et al.Effect of remimazolam induction on hemodynamics in patients undergoing valve replacement surgery：arandomized，double-blind，controlled trial［J］.Pharmacol Res Perspect，2021，9（5）：e00851.doi：10.1002/prp2.851http://dx.doi.org/10.1002/prp2.851.

Dhawan N，Chauhan S，Kothari SS，et al.Hemodynamic responses to etomidate in pediatric patients with congenital cardiac shunt lesions［J］.J CardiothoracVasc Anesth，2010，24（5）：802-807.doi：10.1053/j.jvca.2010.02.005http://dx.doi.org/10.1053/j.jvca.2010.02.005.

Mathews GC，Diamond JS.Neuronal glutamate uptake contributes to GABA synthesis and inhibitory synaptic strength［J］.J Neurosci，2003，23（6）：2040-2048.doi：10.1523/JNEUROSCI.23-06-02040.2003http://dx.doi.org/10.1523/JNEUROSCI.23-06-02040.2003.

Abou Arab O，Fischer MO，Carpentier A，et al.Etomidate-induced hypotension： a pathophysiological approach using arterial elastance［J］.Anaesth Crit Care Pain Med，2019，38（4）：347-352.doi：10.1016/j.accpm.2018.12.006http://dx.doi.org/10.1016/j.accpm.2018.12.006.

张云云，汪小海，艾尼•买买提明，等.丙泊酚与依托咪酯对全麻诱导后低血压发生率的影响分析［J］.药学与临床研究，2021，29（1）：31-34.doi：10.13664/j.cnki.pcr.2021.01.008http://dx.doi.org/10.13664/j.cnki.pcr.2021.01.008.

Wang J，Li Y，Su H，et al.Carotid artery corrected flow time and respiratory variations of peak blood flow velocity for prediction of hypotension after induction of general anesthesia in elderly patients［J］.BMC geriatrics，2022，22（1）：882.doi：10.1186/s12877-022-03619-xhttp://dx.doi.org/10.1186/s12877-022-03619-x.

Tang F，Yi JM，Gong HY，et al.Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia［J］.World J Clin Cases，2021，9（34）：10595-10603.doi：10.12998/wjcc.v9.i34.10595http://dx.doi.org/10.12998/wjcc.v9.i34.10595.

Qiu Y，Gu W，Zhao M，et al.The hemodynamic stability of remimazolam compared with propofol in patients undergoing endoscopic submucosal dissection：a randomized trial［J］.Front Med （Lausanne），2022，9：938940.doi：10.3389/fmed.2022.938940http://dx.doi.org/10.3389/fmed.2022.938940.

Wongtangman K，Wachtendorf LJ，Blank M，et al.Effect of intraoperative arterial hypotension on the risk of perioperative stroke after noncardiac surgery：a retrospective multicenter cohort study［J］. Anesth Analg，2021，133（4）：1000-1008.doi：10.1213/ANE.0000000000005604http://dx.doi.org/10.1213/ANE.0000000000005604.

Kim KM，Park S，Kang BJ，et al.Do epoch lengths of hypnotic depth indicators affect estimated of blood-brain equilibration rate constants of propofol？［J］.J Pharmacokinet Pharmacodyn，2021，48（2）：305-317.doi：10.1007/s10928-020-09733-whttp://dx.doi.org/10.1007/s10928-020-09733-w.

史媛，董贝贝，于泳浩.胃肠内镜检查中镇静镇痛药物应用的研究进展［J］.中国医药导报，2020，17（34）：64-67.

Kilpatrick GJ，McIntyre MS，Cox RF，et al.CNS 7056：a novel ultra-short-acting benzodiazepine［J］.Anesthesiology，2007，107（1）：60-66.doi：10.1097/01.anes.0000267503.85085.c0http://dx.doi.org/10.1097/01.anes.0000267503.85085.c0.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

四维血流磁共振成像在门静脉系统中的应用现状

依托咪酯对四氯化碳诱导的大鼠肝损伤的保护作用

免气腹悬吊式单孔腹腔镜在全子宫及附件切除术中的应用效果

酒石酸布托啡诺对冠状动脉旁路移植术丙泊酚麻醉诱导期血流动力学的影响

老年患者行股骨转子间骨折内固定术后并发谵妄的相关因素分析