全身麻醉中瑞马唑仑对术后恶心呕吐影响的研究进展
Research Progress on the Effects of Remimazolam on Postoperative Nausea and Vomiting during General Anesthesia
DOI: 10.12677/acm.2026.1693242, PDF,   
作者: 李 琴, 王雯静：延安大学医学院，陕西 延安；延安大学附属医院麻醉与围术期学科，陕西 延安；李玲霞*：延安大学附属医院麻醉与围术期学科，陕西 延安
关键词: 瑞马唑仑；全身麻醉；术后恶心呕吐；静脉麻醉；围术期管理；个体化医学；Remimazolam； General Anesthesia； Postoperative Nausea and Vomiting； Intravenous Anesthesia； Perioperative Management； Personalized Medicine
摘要: 术后恶心呕吐(PONV)是全身麻醉后发生率高、严重影响围术期加速康复的常见并发症，其发生与麻醉药物类型、镇静深度、血流动力学稳定性及阿片类药物用量密切相关。瑞马唑仑作为新型超短效水溶性苯二氮䓬类静脉麻醉药，具有起效快、代谢迅速、无蓄积、可被氟马西尼特异性拮抗、血流动力学平稳及无注射痛等优势，已逐步应用于全身麻醉诱导与维持。近年来大量临床研究探讨瑞马唑仑对PONV的影响，结果显示其在降低PONV风险方面显著优于吸入麻醉药，与丙泊酚总体相当且在特殊人群中更具安全性。本文围绕瑞马唑仑调控PONV的药理机制、临床对比证据、高危人群应用、剂量优化及多模式防控策略进行系统综述，分析当前研究存在的异质性与局限性，为临床个体化选择麻醉药物、优化围术期PONV管理提供循证依据。
Abstract: Postoperative nausea and vomiting (PONV) is a common complication after general anesthesia and substantially impairs enhanced recovery after surgery. Its occurrence is closely associated with anesthetic choice, depth of sedation, hemodynamic stability, and opioid consumption. Remimazolam is a novel ultra-short-acting, water-soluble benzodiazepine intravenous anesthetic with rapid onset, rapid metabolism, minimal accumulation, specific reversibility by flumazenil, stable hemodynamics, and no injection pain. It has been increasingly used for the induction and maintenance of general anesthesia. Recent clinical studies have investigated the effect of remimazolam on PONV. Overall, remimazolam appears to reduce PONV more effectively than inhalational anesthetics and has a PONV profile broadly comparable to propofol, with potential safety advantages in selected populations. This review summarizes the pharmacological mechanisms, comparative clinical evidence, high-risk populations, individualized dosing, and multimodal prevention strategies related to remimazolam and PONV. It also discusses the heterogeneity and limitations of current evidence to provide an evidence-based framework for individualized anesthetic selection and perioperative PONV management.
文章引用：李琴, 王雯静, 李玲霞. 全身麻醉中瑞马唑仑对术后恶心呕吐影响的研究进展[J]. 临床医学进展, 2026, 16(9): 1987-1993. https://doi.org/10.12677/acm.2026.1693242

参考文献

[1] 中华医学会麻醉学分会《术后恶心呕吐诊疗指南(2025版)》工作组. 术后恶心呕吐诊疗指南(2025版) [J]. 中华麻醉学杂志, 2025, 45(9): 1080-1103.
[2] 滕云鹏, 薛荣亮, 熊虹飞, 等. 瑞马唑仑对妇科腹腔镜手术患者术后恶心呕吐的影响[J]. 世界临床药物, 2023, 44(7): 714-718.
[3] 程亮, 徐晖, 徐成飞, 等. 瑞马唑仑减少术后恶心呕吐的研究进展[J]. 淮海医药, 2025, 43(3): 323-327.
[4] Kim, S.Y., Sim, K.M., Na, H., Koo, B. and Shin, H. (2024) Effect of Remimazolam for General Anesthesia on Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis. Die Anaesthesiologie, 73, 685-693.
https://doi.org/10.1007/s00101-024-01454-w
[5] Hu, Q., Liu, X., Wen, C., Li, D. and Lei, X. (2022) Remimazolam: An Updated Review of a New Sedative and Anaesthetic. Drug Design, Development and Therapy, 16, 3957-3974.
https://doi.org/10.2147/dddt.s384155
[6] Zhang, H., Li, H., Zhao, S. and Bao, F. (2024) Remimazolam in General Anesthesia: A Comprehensive Review of Its Applications and Clinical Efficacy. Drug Design, Development and Therapy, 18, 3487-3498.
https://doi.org/10.2147/dddt.s474854
[7] Murrell, D.E. and Harirforoosh, S. (2025) Clinical Pharmacokinetics, Pharmacodynamics, and Drug Interactions of Remimazolam. European Journal of Drug Metabolism and Pharmacokinetics, 50, 449-460.
https://doi.org/10.1007/s13318-025-00963-2
[8] Horn, C.C., Wallisch, W.J., Homanics, G.E. and Williams, J.P. (2014) Pathophysiological and Neurochemical Mechanisms of Postoperative Nausea and Vomiting. European Journal of Pharmacology, 722, 55-66.
https://doi.org/10.1016/j.ejphar.2013.10.037
[9] Rajan, N. and Joshi, G.P. (2021) Management of Postoperative Nausea and Vomiting in Adults: Current Controversies. Current Opinion in Anaesthesiology, 34, 695-702.
https://doi.org/10.1097/aco.0000000000001063
[10] Matsumoto, A., Satomi, S., Kakuta, N., Narasaki, S., Toyota, Y., Miyoshi, H., et al. (2023) Remimazolam’s Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial. Journal of Clinical Medicine, 12, Article No. 5402.
https://doi.org/10.3390/jcm12165402
[11] Ri, H., Jeon, S., Yeo, J., Jung, H., Kang, C. and Choo, H. (2025) Efficacy of Remimazolam in Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis. Scientific Reports, 15, Article No. 29236.
https://doi.org/10.1038/s41598-025-14976-z
[12] Yoo, Y.M., Park, J.H., Lee, K.H., Yi, A.H. and Kim, T.K. (2024) The Incidences of Nausea and Vomiting after General Anesthesia with Remimazolam versus Sevoflurane: A Prospective Randomized Controlled Trial. Korean Journal of Anesthesiology, 77, 441-449.
https://doi.org/10.4097/kja.23939
[13] Hari, Y., Satomi, S., Murakami, C., Narasaki, S., Morio, A., Kato, T., et al. (2022) Remimazolam Decreased the Incidence of Early Postoperative Nausea and Vomiting Compared to Desflurane after Laparoscopic Gynecological Surgery. Journal of Anesthesia, 36, 265-269.
https://doi.org/10.1007/s00540-022-03041-y
[14] Kim, E.J., Kim, C.H., Yoon, J.Y., Byeon, G.J., Kim, H.Y. and Choi, E. (2023) Comparison of Postoperative Nausea and Vomiting between Remimazolam and Propofol in Patients Undergoing Oral and Maxillofacial Surgery: A Prospective Randomized Controlled Trial. BMC Anesthesiology, 23, Article No. 132.
https://doi.org/10.1186/s12871-023-02091-3
[15] Kovac, A.L. (2021) Postoperative Nausea and Vomiting in Pediatric Patients. Pediatric Drugs, 23, 11-37.
https://doi.org/10.1007/s40272-020-00424-0
[16] Gan, T.J., Belani, K.G., Bergese, S., Chung, F., Diemunsch, P., Habib, A.S., et al. (2020) Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia & Analgesia, 131, 411-448.
https://doi.org/10.1213/ane.0000000000004833
[17] Vashisht, A., Vashisht, A., Maratha, L. and Verma, A. (2025) Hemodynamic and Postoperative Benefits of Remimazolam over Sevoflurane: A Comparative Meta-Analysis. Journal of Cardiothoracic and Vascular Anesthesia, 39, 3313-3327.
https://doi.org/10.1053/j.jvca.2025.09.003
[18] Xue, R., Sun, R., Wang, M., Guo, H. and Chang, J. (2025) Comparison of Remimazolam and Propofol on Postoperative Subjective Quality of Recovery in Patients Undergoing General Anesthesia: A Meta-Analysis of Randomized Controlled Trials. Minerva Anestesiologica, 91, 191-200.
https://doi.org/10.23736/s0375-9393.24.18395-2
[19] 赵相中, 韩二营, 陈金业, 等. 瑞马唑仑/丙泊酚联合瑞芬太尼麻醉对斜视手术患儿血流动力学及恶心呕吐的影响[J]. 中国药物与临床, 2024, 24(19): 1285-1288.
[20] Ryo, M., Hayashi, T., Miyasaka, K., Yonekura, Y., Fujita, N. and Abe, S. (2025) Increased Incidence of Postoperative Nausea and Vomiting with Remimazolam Compared to Propofol Following Breast Surgery: A Single-Center, Retrospective Cohort Study. Cureus, 17, e86592.
https://doi.org/10.7759/cureus.86592
[21] Yi, F., Xiao, H., Zhu, T., Man, Y. and Ji, F. (2022) Prevention of Postoperative Nausea and Vomiting after Gynaecological Day Surgery under Remimazolam General Anesthesia: A Randomized Double-Blind Controlled Study. BMC Anesthesiology, 22, Article No. 292.
https://doi.org/10.1186/s12871-022-01835-x
[22] Schwartz, J. and Gan, T.J. (2020) Management of Postoperative Nausea and Vomiting in the Context of an Enhanced Recovery after Surgery Program. Best Practice & Research Clinical Anaesthesiology, 34, 687-700.
https://doi.org/10.1016/j.bpa.2020.07.011
[23] Weibel, S., Rücker, G., Eberhart, L.H., Pace, N.L., Hartl, H.M., Jordan, O.L., et al. (2020) Drugs for Preventing Postoperative Nausea and Vomiting in Adults after General Anaesthesia: A Network Meta-Analysis. Cochrane Database of Systematic Reviews, 2020, CD012859.
https://doi.org/10.1002/14651858.cd012859.pub2
[24] Park, S., Yon, J.H., Lee, S., Kim, K. and Jun, I. (2025) Efficacy of Intraoperative Low-Dose Remimazolam as a Third Antiemetic Agent for Preventing Early Postoperative Nausea in High-Risk Patient: A Randomized Controlled Trial. BMC Anesthesiology, 25, Article No. 442.
https://doi.org/10.1186/s12871-025-03332-3
[25] Lee, S.C., Jung, J.W., Choi, S.R., Chung, C.J., Lee, T.Y. and Park, S.Y. (2023) Comparison of Postoperative Nausea and Vomiting Incidence between Remimazolam and Sevoflurane in Tympanoplasty with Mastoidectomy: A Single-Center, Double-Blind, Randomized Controlled Trial. Medicina, 59, Article No. 1197.
https://doi.org/10.3390/medicina59071197

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