瑞马唑仑对腹腔镜胃癌手术患者的血流动力学影响

The Hemodynamic Effects of Remimazolam on Patients Undergoing Laparoscopic Gastric Cancer Surgery

摘要: 目的：探讨瑞马唑仑应用于腹腔镜胃癌手术患者的临床效果，并观察其对血流动力学的影响。方法：选取择期全麻下行腹腔镜胃癌手术患者80例，男68例，女12例，年龄50~75岁，BMI 18~27 kg/m2，ASA分级为I~II级。采用随机数字表法分为两组：瑞马唑仑(R)组(P)组，每组40例。记录诱导前(T0)、切皮(T1)、手术开始2 h (T2)、术毕(T3)、拔管时刻(T4)各组平均动脉压(MAP)、心率(HR)、心排量(CO)、全身血管阻力(SVR)。结果：TO时刻两组MAP、HR、CO、SVR差异无统计学意义。组间比较：P组在T1~T4各时间点HR、CO、MAP均低于R组，SVR在T1~T4各时间点均高于R组(P < 0.05)。组内比较：P组CO、MAP、HR在T1~T4各时间点较T0时刻均明显下降(P < 0.05)，SVR在T1~T4各时间均明显高于T0时刻(P < 0.05)。R组CO、MAP、SVR在T1~T4各时间点与T0时刻比较有下降趋势，差异无统计学意义。结论：静脉应用瑞马唑仑全身麻醉对老年胃癌手术患者的心输出量影响较小，较丙泊酚全身麻醉血流动力学更稳定。

Abstract: Objective: To investigate the clinical effect of remimazolam in patients undergoing laparoscopic gastric cancer surgery and observe its influence on hemodynamics. Methods: Eighty patients (68 males and 12 females) undergoing laparoscopic gastric cancer surgery under selective general an-esthesia were selected, aged 50~75 years, with BMI of 18~27 kg/m2 and ASA grade of I~II. Ran-domly divided into two groups: group (R) and group (P) with 40 cases in each group. The mean ar-terial pressure (MAP), heart rate (HR), cardiac output (CO) and systemic vascular resistance (SVR) were recorded before induction (T0), skin incision (T1), 2 h after operation (T2), after operation (T3) and extubation time (T4). Results: there was no significant difference in MAP, HR, CO and SVR between the two groups at the time of TO. Comparison between groups: HR, CO and MAP in group P were lower than those in group R at all time points from T1 to T4, and SVR was higher than that in group R at all time points from T1 to T4 (P < 0.05). Intra-group comparison: CO, MAP and HR in group P were significantly lower than at time T0 (P < 0.05), and SVR was significantly higher at time T1~T4 than at time T0 (P < 0.05). CO, MAP and SVR in group R showed a downward trend from T1 to T4 compared with T0, and the difference was not statistically significant. Conclusion: Intravenous general anesthesia with remimazolam has little effect on cardiac output of elderly patients under-going gastric cancer surgery, and its hemodynamics is more stable than propofol general anesthe-sia.