瑞马唑仑预防蛛网膜下腔麻醉下剖宫产术围术期恶心呕吐的研究进展

Research Progress on Remimazolam for Preventing Perioperative Nausea and Vomiting in Cesarean Section under Spinal Anesthesia

摘要: 临床上，剖宫产手术恶心呕吐的发生率高，而蛛网膜下腔麻醉下剖宫产患者恶心呕吐的发生率更高，给手术安全性和病人的舒适度造成不小的影响，严重的呕吐误吸甚至会危及生命。因此，预防蛛网膜下腔麻醉下剖宫产患者围术期恶心呕吐对产妇的安全至关重要。很多研究表明咪达唑仑可以预防剖宫产患者术中的恶心呕吐，瑞马唑仑作为新型超短效苯二氮卓类药物，不仅具有了咪达唑仑所具有的镇静、催眠、抗焦虑等作用，还弥补了咪达唑仑在起效时间、消除速率和药物蓄积上的不足。在预防剖宫产患者恶心呕吐方面，瑞马唑仑可能是一个更优的选择。产妇恶心呕吐的影响因素较多，本文探讨了剖宫产患者恶心呕吐的影响因素、苯二氮卓类药物的作用机制及瑞马唑仑的镇静优势，为预防剖宫产患者恶心呕吐的治疗方面提供新的选择。

Abstract: Clinically, nausea and vomiting are common during cesarean section, and the incidence is even higher in patients undergoing cesarean section under spinal anesthesia. This significantly impacts surgical safety and patient comfort, and severe vomiting and aspiration can even be life-threatening. Effective prevention of perioperative nausea and vomiting in this patient population is paramount for maternal safety. Numerous studies have demonstrated the efficacy of midazolam in mitigating these symptoms during cesarean sections. Remimazolam, as a novel ultra-short-acting benzodiazepine, not only possesses the sedative, hypnotic, and anxiolytic effects of midazolam, but also overcomes the shortcomings of midazolam in terms of onset time, elimination rate, and drug accumulation. Consequently, remimazolam presents a promising alternative for preventing nausea and vomiting in cesarean section patients. This review explores the factors influencing nausea and vomiting in postpartum women undergoing cesarean sections, elucidates the mechanisms of benzodiazepines, highlights the sedative benefits of remimazolam, and proposes it as a novel strategy for managing these symptoms in this patient population.