瑞马唑仑对不停跳冠状动脉搭桥术麻醉诱导期间血流动力学及术后认知功能影响的研究

Research on the Effects of Remimazolam on Hemodynamics and Postoperative Cognitive Function during Anesthesia Induction in Off-Pump Coronary Artery Bypass Grafting

摘要: 目的：探讨苯磺酸瑞马唑仑对不停跳冠状动脉搭桥术(OPCABG)麻醉诱导的镇静效果及对血流动力学和术后认知功能的影响。方法：采用随机数字表法将40例择期行OPCABG的患者随机分为丙泊酚组(A组)和瑞马唑仑组(B组)，每组20例。全麻诱导时A组静脉推注丙泊酚1.5 mg/kg，B组静脉推注瑞马唑仑0.3 mg/kg，给药过程在30秒内完成，待脑电波双频指数(BIS) 60时，给予舒芬太尼0.8~1.0 ug/kg、顺式阿曲库铵0.3~0.5 mg/kg继续麻醉诱导，当肌肉松弛，进行气管插管。观察记录从麻醉诱导开始到BIS为60所需要的时间；记录给药前(T0)、BIS < 60时(T1)、插管前(T2)、插管后1分钟(T3)、手术开始(T4)、手术结束(T5)的BIS值、平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、心脏指数(CI)及每搏输出量指数(SVI)；比较两组患者全麻诱导的镇静效果，术中血流动力学变化情况，是否发生术中知晓，术后认知功能及术后躁动、谵妄等不良反应的发生情况。结果：观察组诱导后BIS < 60所需要的时间为59.40 ± 2.33 s，明显低于对照组67.10 ± 3.77 s，差异有统计学意义(P < 0.05)。观察组麻醉诱导期间血流动力学变化小，两组均无不良事件的发生。结论：瑞马唑仑OPCABG患者麻醉诱导期间血流动力学变化影响更小，能更快地达到满意的麻醉深度，且无术后不良事件的发生，可用于OPCABG的麻醉诱导，具有较高安全性。

Abstract: Objective: To investigate the sedative effects of remimazolam besylate during anesthesia induction for off-pump coronary artery bypass grafting (OPCABG), and its impact on hemodynamics and postoperative cognitive function. Methods: Forty patients scheduled for elective OPCABG were randomly divided into two groups using a random number table method: the propofol group (Group A) and the remimazolam group (Group B), with 20 patients in each group. During general anesthesia induction, Group A received an intravenous injection of propofol at 1.5 mg/kg, while Group B received an intravenous injection of remimazolam at 0.3 mg/kg, both administered within 30 seconds. When the bispectral index (BIS) reached 60, sufentanil 0.8~1.0 μg/kg and cisatracurium 0.3~0.5 mg/kg were administered to continue anesthesia induction. Tracheal intubation was performed upon achieving muscle relaxation. The time from the start of anesthesia induction to BIS reaching 60 was recorded. BIS values, mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), and stroke volume index (SVI) were recorded at the following time points: before administration (T0), when BIS < 60 (T1), before intubation (T2), 1 minute after intubation (T3), at the start of surgery (T4), and at the end of surgery (T5). The sedative effects of general anesthesia induction, intraoperative hemodynamic changes, intraoperative awareness, postoperative cognitive function, and the occurrence of adverse reactions such as postoperative agitation and delirium were compared between the two groups. Results: The time required for BIS to drop below 60 after induction in the observation group was 59.40 ± 2.33 seconds, significantly lower than the control group’s 67.10 ± 3.77 seconds, with a statistically significant difference (P < 0.05). Hemodynamic changes during anesthesia induction were smaller in the observation group, and no adverse events occurred in either group. Conclusion: Remimazolam results in smaller hemodynamic changes during anesthesia induction in OPCABG patients, achieves satisfactory anesthesia depth more quickly, and is not associated with postoperative adverse events. It can be used for anesthesia induction in OPCABG with high safety.