2022 年第 1 期 第 17 卷

瑞马唑仑联合舒芬太尼对行胸腔镜手术患者炎症因子及疼痛介质和应激反应指标水平的影响

Effects of remimazolam combined with sufentanil on inflammation factors, pain mediators and stress response indicators levels in patients undergoing thoracoscopic surgery

作者：俞晓东张文奇康文越蒙亚珍

英文作者：Yu Xiaodong Zhang Wenqi Kang Wenyue Meng Yazhen

单位：海南省人民医院麻醉科，海口570311

英文单位：Department of Anesthesiology Hainan General Hospital Haikou 570311 China

关键词：瑞马唑仑；舒芬太尼；胸腔镜手术；炎症因子；疼痛介质

英文关键词：Remimazolam;Sufentanil;Thoracoscopicsurgery;Inflammatoryfactors;Painmediators

• 摘要：

• 目的 探讨瑞马唑仑联合舒芬太尼对行胸腔镜手术（VATS）患者炎症因子、疼痛介质和应激反应指标水平的影响。方法 选取2019年5月至2020年10月于海南省人民医院择期行VATS的患者102例，按照抽签法分为对照组和观察组，各51例。对照组予舒芬太尼麻醉，观察组在对照组基础上联合甲苯磺酸瑞马唑仑麻醉。比较2组患者手术前后炎症因子、疼痛介质、应激反应指标水平，以及术后疼痛视觉模拟量表评分、Ramsay镇静评分、不良反应发生情况。结果 术后2、12、24 h，2组血清白细胞介素10（IL-10）、IL-6、肿瘤坏死因子α（TNF-α）水平均高于术前，且观察组术后各时点IL-10水平均高于对照组［（10.6±2.2）ng/L比（7.5±1.7）ng/L、（16.2±2.4）ng/L比（9.2±1.8）ng/L、（17.2±2.2）ng/L比（10.6±2.1）ng/L］，IL-6、TNF-α水平均低于对照组，差异均有统计学意义（均P＜0.05）；术后各时点2组血清前列腺素E2、IL-17水平均高于术前，高迁移率族蛋白1（HMGB1）水平均低于术前，且观察组各时点前列腺素E2、HMGB1、IL-17水平均低于对照组，差异均有统计学意义（均P＜0.05）；术后各时点2组血浆肾上腺素、去甲肾上腺素、皮质醇、空腹血糖水平均高于术前，且术后各时点观察组均低于对照组，差异均有统计学意义（均P＜0.05）。术后2、12 h，观察组VAS评分低于对照组，Ramsay镇静评分均高于对照组，差异均有统计学意义（均P＜0.05）。2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论  行VATS患者使用瑞马唑仑联合舒芬太尼麻醉可抑制炎症因子及疼痛介质水平，减轻应激反应，且具有一定的安全性。

• Objective   To investigate the effects of remimazolam combined with sufentanil on inflammation factors, pain mediators and stress response indicators levels in patients undergoing thoracoscopic surgery (VATS). Methods  From May 2019 to October 2020, 102 patients undergoing elective VATS in Hainan General Hospital were enrolled. According to lottery method, they were divided into the control group and the observation group, with 51 cases in each group. The control group was given sufentanil anesthesia, and the observation group was given remifentanil tosilate anesthesia on the basis of the control group. The levels of inflammation factors, pain mediators and stress response indicators before and after operation, pain visual analogue scale (VAS) score, Ramsay score and adverse reaction after operation were compared between the two groups. Results  After 2, 12, 24 h of operation, the serum levels of interleukin-10 (IL-10), IL-6 and tumor necrosis factor-α (TNF-α) in both groups were higher than those before operation, the IL-10 levels in the observation group at each time point were higher than those in the control group［（10.6±2.2）ng/L vs （7.5±1.7）ng/L, （16.2±2.4）ng/L vs （9.2±1.8）ng/L,（17.2±2.2）ng/L vs （10.6±2.1）ng/L］, and the IL-6 and TNF-α levels in the observation group were higher than those in the control group (all P<0.05); the serum levels of prostaglandin E2 and IL-17 in both groups at each time point after operation were higher than those before operation, and the high mobility group protein 1 (HMGB1) levels were lower than those before operation, and the levels of prostaglandin E2, IL-17 and HMGB1 in the observation group at each time point were lower than those in the control group (all P<0.05); the plasma levels of epinephrine, norepinephrine, cortisol and fasting blood glucose in both groups at each time point after operation were higher than those before operation, and those in the observation group were lower than those in the control group (all P<0.05). After 2 and 12 h of operation, VAS scores in the observation were lower than those in the control group and Ramsay sedation scores in the observation group were higher than those in the control group (all P<0.05). There were no significant difference in incidence of adverse reactions between the two groups (P>0.05). Conclusion  Remimazolam combined with sufentanil anesthesia can inhibit the levels of inflammatory factors and pain mediators in patients undergoing VATS, and reduce stress response, with certain safty.