中国妇幼保健

目的 对比瑞马唑仑与丙泊酚用于妇科手术全凭静脉麻醉的临床效果。方法 选取2022年10月—2024年10月赣南医科大学第一附属医院龙南分院(龙南市第一人民医院)收治的接受妇科手术患者128例，按照1∶1匹配的病例对照设计分为瑞马唑仑组(64例)与丙泊酚组(64例)。两组均采取全凭静脉麻醉，瑞马唑仑组采用甲苯磺酸瑞马唑仑诱导及维持，丙泊酚组采用丙泊酚诱导及维持。比较两组麻醉相关指标、围手术期不良反应，麻醉前(T0)、麻醉诱导5 min后(T1)、手术结束时(T2)的循环稳定性[平均动脉压(MAP)、血氧饱和度(SpO₂)、心率(HR)]以及术后1 h、12 h、24 h的镇静效果及认知情况。结果 瑞马唑仑组麻醉诱导起效时间(38.49±5.24)s、手术时间(58.64±5.49)min、苏醒时间(5.29±0.63)min、定向力恢复时间(7.29±1.64)min、住院时间(11.69±2.35)d均短于丙泊酚组的(45.64±4.78)s、(62.91±6.67)min、(6.48±1.15)min、(8.55±1.70)min、(13.11±3.24)d,差异均有统计学意义(t=8.065、3.954、7.260、4.267、2.838,均P<0.05)。T1时瑞马唑仑组MAP(79.24±3.78)mm Hg、SpO₂(93.36±1.21)%、HR(67.35±3.49)次/min均高于丙泊酚组的(75.35±4.24)mm Hg、(91.69±1.46)%、(65.12±3.29)次/min; T2时瑞马唑仑组MAP(84.11±4.15)mm Hg、SpO₂(95.14±0.65)%、HR(71.89±3.86)次/min均高于丙泊酚组的(81.59±3.97)mm Hg、(93.87±1.01)%、(69.20±3.68)次/min,差异均有统计学意义(均P<0.05)。镇静与认知指标方面，术后1 h、12 h、24 h瑞马唑仑组视觉模拟疼痛评分(VAS)分别为(2.42±0.42)分、(3.11±0.45)分、(1.88±0.29)分，均低于丙泊酚组的(2.58±0.36)分、(3.43±0.39)分、(2.10±0.30)分；警觉-镇静评分量表(OAAS)评分分别为(3.58±0.32)分、(4.49±0.43)分、(4.88±0.39)分，均高于丙泊酚组的(3.12±0.29)分、(3.89±0.24)分、(4.32±0.35)分；简易智能状态检查量表(MMSE)评分分别为(18.64±2.84)分、(25.33±3.24)分、(27.33±1.28)分，均高于丙泊酚组的(17.59±2.96)分、(24.11±2.68)分、(26.89±1.14)分，差异均有统计学意义(均P<0.05)。两组围手术期不良事件发生率(7.81%vs.12.50%)比较，差异无统计学意义(χ²=0.771,P>0.05)。结论 瑞马唑仑用于妇科手术全凭静脉麻醉可让患者更快进入麻醉状态，结束麻醉后更快清醒，且术中循环稳定性良好，值得临床推广。

Objective To compare the clinical effect of remimazolam and propofol for total intravenous anesthesia in gynecological surgery.Methods A total of 128 patients undergoing gynecological surgery in Longnan Branch of the First Affiliated Hospital of Gannan Medical University(Longnan First People's Hospital) were enrolled as the research objects between October 2022 and October 2024.According to 1∶1 matched case-control design, they were divided into remimazolam group(64 cases) and propofol group(64 cases).On basis of total intravenous anesthesia, remimazolam group was given remimazolam mesylate, while propofol group was given propofol for induction and maintenance.The anesthesia-related indexes, perioperative adverse reactions, circulatory stability [mean arterial pressure(MAP),blood oxygen saturation(SpO₂),heart rate(HR)] before anesthesia(T0),at 5min after anesthesia induction(T1) and end of the surgery(T2),sedative effect and cognition at 1 h, 12 h and 24 h after surgery were compared between the two groups.Results The onset time of anesthesia induction, operation time, awaking time, recovery time of orientation and length of hospital stay in remimazolam group were all shorter than those in propofol group [(38.49±5.24) s,(58.64±5.49) min,(5.29±0.63) min,(7.29±1.64) min,(11.69±2.35) d vs.(45.64±4.78) s,(62.91±6.67) min,(6.48±1.15) min,(8.55±1.70) min,(13.11±3.24) d],the difference were statistically significant(t=8.065,3.954,7.260,4.267,2.838,P<0.05).At T1 and T2,MAP,SpO₂ and HR in remimazolam group were higher than those in propofol group [(79.24±3.78) mm Hg,(93.36±1.21) %,(67.35±3.49) beats/min vs.(75.35±4.24) mm Hg,(91.69±1.46) %,(65.12±3.29) beats/min;(84.11±4.15) mm Hg,(95.14±0.65) %,(71.89±3.86) beats/min vs.(81.59±3.97) mm Hg,(93.87±1.01) %,(69.20±3.68) beats/min],the difference were statistically significant(P<0.05).At 1 h, 12 h and 24 h after surgery, VAS scores in remimazolam group were lower than those in propofol group [(2.42±0.42) points,(3.11±0.45) points,(1.88±0.29) points vs.(2.58±0.36) points,(3.43±0.39) points,(2.10±0.30) points],while scores of OAAS and MMSE were higher than those in propofol group [(3.58±0.32) points,(4.49±0.43) points,(4.88±0.39) points vs.(3.12±0.29) points,(3.89±0.24) points,(4.32±0.35) points;(18.64±2.84) points,(25.33±3.24) points,(27.33±1.28) points vs.(17.59±2.96) points,(24.11±2.68) points,(26.89±1.14) points],the difference were statistically significant(P<0.05).There was no significant difference in incidence of perioperative adverse events between the two groups(7.81% vs. 12.50%,χ²=0.771,P>0.05).Conclusion The total intravenous anesthesia with remimazolam in gynecological surgery has shorter anesthesia onset time, faster awaking after anesthesia and good intraoperative circulation stability.