瑞马唑仑对心脏瓣膜置换术全麻诱导期间血流动力学及术后认知功能的影响研究

Effects of remazolam on hemodynamics and immediate postoperative cognitive function during general anesthesia induction in heart valve replacement surgery

摘要:

目的 观察瑞马唑仑对心脏瓣膜置换术患者全麻诱导期间的血流动力及术后即刻认知功能的影响。方法 本文为前瞻性研究，病例纳入时间为2020年6月至2023年5月，研究对象为郑州市第七人民医院收治的98例心脏瓣膜置换术患者，采用随机数字表法对入组患者进行分组，分别列为观察组（49例）和对照组（49例），对照组实施常规全身麻醉，观察组采用瑞马唑仑辅助全身麻醉，比较两组患者全麻诱导期间的血流动力学变化情况，麻醉镇静深度，术后即刻认知功能及麻醉相关副反应发生情况。结果 给药前（T0），给药后即刻（T1），诱导5 min时（T2）两组的心率（HR）、平均动脉压（MAP）差异无统计学意义（P>0.05）；气管插管即刻（T3）时，观察组的HR为（79.25±10.17）次/min，MAP为（115.74±20.61）mmHg，均低于对照组［（85.75±10.24）次/min、（130.41±20.77）mmHg］；插管后5 min时（T4），观察组的HR为（78.62±10.61）次/min，MAP为（108.44±20.25）mmHg，均低于对照组［（84.27±10.32）次/min、（120.25±20.27）mmHg］，差异有统计学意义（P<0.05）。在不同麻醉方案下，观察组诱导后脑电双频指数（BIS）≤60耗时为（60.25±10.36）s，气管插管前BIS值为（58.24±10.61），均低于对照组［（67.25±10.41）s、（65.77±10.46）］，差异有统计学意义（P<0.05）。在不同麻醉方案下，观察组术后即刻的简易精神状态检查量表（MMSE）评分为（26.62±5.13）分，蒙特利尔认知评估量表（MoCA）评分为（25.45±5.17）分，均高于对照组［（23.11±5.46）分、（22.16±5.24）分］，差异有统计学意义（P<0.05）。在不同麻醉方案下，观察组的麻醉相关不良反应发生率为12.24%（6/49），略高于对照组10.20%（5/49），差异无统计学意义（P>0.05）。结论 瑞马唑仑辅助全身麻醉能有效维持心脏瓣膜置换术患者诱导期间的血流动力学稳定，对帮助患者更快达到满意麻醉深度并降低术后即刻认知障碍均有积极意义，联合应用此药未明显增加不良反应发生风险，安全性较高。

Abstract:

Objective To observe the effect of remazolam on hemodynamics during induction of general anesthesia and immediate postoperative cognitive function in patients undergoing heart valve replacement surgery.Methods This is a prospective cohort study. The patients were included from June 2020 to May 2023. The study subjects were 98 patients with heart valve replacement. The enrolled patients were divided into the observation group (49 cases) and the control group (49 cases) by using the random number table. The control group was given routine general anesthesia. The observation group was given ramazolam assisted general anesthesia. The hemodynamic changes, depth of anesthesia and sedation, immediate postoperative cognitive function, and occurrence of anesthesia related side effects of the patients in the two groups were compared during the induction of general anesthesia.Results There was no statistically significant difference in heart rate (HR) and mean arterial pressure (MAP) between the two groups of patients before administration (T0), immediately after administration (T1), and after induction for 5 minutes (T2) (P>0.05). At the instant of tracheal intubation (T3), HR and MAP of the observation group were 79.25±10.17 times/min and 115.74±20.61 mmHg, respectively, which were lower than those of the control group (85.75±10.24 times/min and 130.41±20.77 mmHg). At 5 minutes after intubation (T4), the HR and MAP of the observation group were 78.62±10.61 times/min and 108.44±20.25 mmHg, respectively; compared with the control group (84.27±10.32 times/min and 120.25±20.27 mmHg), the above indicators were lower (P<0.05). Under different anesthesia schemes, the time of bilateral bispectral index (BIS) ≤60 after induction in the observation group was 60.25±10.36 s, and the BIS value before tracheal intubation was 58.24±10.61; compared with the control group (67.25±10.41 s, 65.77±10.46), the above indicators were lower (P<0.05). Under different anesthesia regimens, the Mini-Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score of the observation group immediately after surgery were 26.62±5.13 and 25.45±5.17, respectively; compared with the control group 23.11±5.46 and 22.16±5.24, the above scores were higher (P<0.05). Under different anesthesia regimens, the incidence of anesthesia related adverse reactions in the observation group was 12.24% (6/49), which was similar to 10.20% (5/49) in the control group (P>0.05).Conclusion Remazolam assisted general anesthesia can effectively maintain hemodynamic stability during induction in patients undergoing heart valve replacement surgery, and has a positive significance in helping patients achieve satisfactory anesthesia depth faster and reducing immediate postoperative cognitive impairment. The combined use of this drug does not significantly increase the risk of adverse reactions and has high safety.