瑞马唑仑与右美托咪定在宫腔镜手术中的麻醉效果比较

Comparison of Anesthetic Effects of Remimazolam and Dexmedetomidine in Hysteroscopic Surgery

摘要: 目的：比较瑞马唑仑与右美托咪定在宫腔镜手术中的麻醉效果。方法：采用随机、单盲的对照研究方法，选择2021年3~9月宫腔镜手术麻醉患者60例，随机数字表法分为两组：R组(瑞马唑仑组)和D组(右美托嘧啶组)。受试者静脉注射枸橼酸舒芬太尼10 ug进行镇痛预处理。D组盐酸右美托咪定注射液负荷量1 μg/kg，泵注10 min后，维持剂量为：0.5 μg/(kg·h)。R组苯磺酸瑞马唑仑7 mg，之后维持剂量为1 mg/(kg·h)。之后两组给予8%的七氟烷吸入麻醉，在患者意识消失以后，咬肌松弛时插入喉罩，术中保留患者自主呼吸，维持七氟烷浓度在2%~3%左右。记录入室后直至操作结束受试者生命体征稳定后的心率、平均动脉压、bis值的差异、诱导时置入喉罩的时间、苏醒时间。结果：麻醉后D组相较于R组心率、bis值、平均动脉压波动幅度更低，差异有统计学意义(P < 0.05)，R组相较于D组诱导时置入喉罩所需时间更短，复苏时间更短，差异均有统计学意义(P < 0.05)。结论：本研究发现瑞马唑仑和右美托嘧啶均可为宫腔镜手术提供有效的镇静，但瑞马唑仑用于宫腔镜的安全性及效率优于右美托嘧啶。

Abstract: Objective: To compare the anesthetic effect of remimazolam and dexmedetomidine in hysteroscopic surgery. Methods: Using a randomized, single-blind control study, 60 patients undergoing hysteroscopic anesthesia from March to September 2021 were randomly divided into two groups: R (remimazolam) and D (dexmedetomidine). All subjects were analgesic pretreated with intravenous sufentanil 10 ug citrate. In Group D, use of dexmedetomidine hydrochloride injection was 1 ug/kg, load pump for 10 min, maintenance dose: 0.5 ug/(kg h) and group R intravenous 7 mg, maintenance dose: 1 mg/(kg h). Both groups were then given inhaled anesthesia with an 8% sevoflurane mask, and the laryngeal mask was started after the patient’s consciousness disappeared and the masseter muscle was relaxed with retained autonomous breathing. The intraoperative sevoflurane concentration was maintained from 2% to 3%, and the heart rate, mean arterial pressure, difference in bis value, time of laryngeal mask at induction, and recovery time after the subject had stable vital signs until the end of the operation were recorded. Results: Group D had lower heart rate, bis value and mean arterial pressure, significantly (P < 0.05), shorter recovery time and shorter recovery time than group D (P < 0.05). Conclusions: This study found that both remimazolam and dexmedetomidine provide effective sedation for hysteroscopic surgery, but remimazolam is better safe than that for hysteroscopy.