2023 年第 8 期 第 18 卷

瑞马唑仑用于宫腔镜鼻咽通气道保留自主呼吸静脉麻醉中的临床效果观察

Observation of clinical effect of remimazolam in intravenous anesthesia of hysteroscopic nasopharyngeal airway with spontaneous breathing

作者：王惠军陈红芽王珊珊王古岩

英文作者：Wang Huijun Chen Hongya Wang Shanshan Wang Guyan

单位：首都医科大学附属北京同仁医院麻醉科，北京100730

英文单位：Department of Anesthesiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China

关键词：宫腔镜；鼻咽通气道；瑞马唑仑；丙泊酚；氟马西尼

英文关键词：Hysteroscopy;Nasopharyngealairway;Remimazolam;Propofol;Flumazenil

• 摘要：

• 目的 观察瑞马唑仑用于宫腔镜鼻咽通气道保留自主呼吸静脉麻醉中的临床效果。方法 选取首都医科大学附属北京同仁医院2022年10月至2023年3月行择期宫腔镜手术的患者123例，采用随机数字表法分为丙泊酚组、瑞马唑仑组和瑞马唑仑+氟马西尼组（简称瑞马氟马组），每组41例。丙泊酚组采用丙泊酚复合羟考酮全凭静脉麻醉；瑞马唑仑组和瑞马氟马组采用瑞马唑仑复合羟考酮全凭静脉麻醉，3组术中均辅用鼻咽通气道，术毕瑞马氟马组静脉注射氟马西尼0.3 mg进行拮抗。主要观察指标是术中呼吸抑制的发生率。次要观察指标包括镇静诱导时间、苏醒时间、围术期血流动力学指标的变化以及围术期其他不良反应的发生情况。结果 瑞马唑仑组和瑞马氟马组的镇静诱导时间均长于丙泊酚组［(44±5)、（45±5）min比(40±3)min］，差异均有统计学意义（均P<0.05），但瑞马唑仑组和瑞马氟马组差异无统计学意义（P>0.05）；瑞马唑仑组和丙泊酚组的苏醒时间均长于瑞马氟马组［(10.0±3.5)、(5.3±1.8)min比(2.0±0.7)min］，差异均有统计学意义（均P<0.05），瑞马唑仑组长于丙泊酚组，差异有统计学意义（P<0.05）。瑞马唑仑组和瑞马氟马组扩张宫颈时、宫内操作时的平均动脉压、心率和脉搏血氧饱和度均高于丙泊酚组，差异均有统计学意义（均P＜0.05）；3组患者诱导前和拔管时的平均动脉压、心率和脉搏血氧饱和度比较，差异均无统计学意义(均P＞0.05)。瑞马唑仑组和瑞马氟马组诱导期注射痛和术中呼吸抑制的发生率均低于丙泊酚组，差异均有统计学意义（均P＜0.05）；3组围术期其他不良反应比较差异均无统计学意义(均P＞0.05)；3组均未见术中知晓和术后呼吸抑制的发生。结论 瑞马唑仑用于鼻咽通气道保留自主呼吸静脉麻醉下的宫腔镜手术患者，与等效剂量丙泊酚相比，呼吸抑制发生率低、血流动力学更平稳，特异性拮抗剂氟马西尼明显缩短了苏醒时间，有利于宫腔镜手术患者的快速康复。

• Objective To observe the clinical effect of remimazolam in intravenous anesthesia of hysteroscopic nasopharyngeal airway with spontaneous breathing. Methods  A total of 123 patients underwent elective hysteroscopic surgery in Beijing Tongren Hospital, Capital Medical University from October 2022 to March 2023 were selected, and they were randomly divided into propofol group, remimazolam group and remimazolam + flumazenil group (remimafluma group for brief), with 41 cases in each group. The propofol group was given total intravenous anesthesia with propofol combined with oxycodone, and the remimazolam group and remimafloxacin group were treated with remimazolam combined with oxycodone total intravenous anesthesia. The nasopharyngeal airway was used during the operation in all the three groups, and flumazenil 0.3 mg was injected intravenously after the operation in remimafluma group. The primary outcome measure was the incidence of intraoperative respiratory depression. The secondary outcome measures included sedation induction time, emergence time, changes in perioperative hemodynamic parameters, and the occurrence of other perioperative adverse reactions. Results The sedation induction times of remimazolam group and remimafuma group were both longer than that of propofol group ［(44±5), (45±5)min vs (40±3)min］(both P<0.05), but there was no significant difference between the remimazolam group and the remimafluma group (P>0.05). The recovery times of remimazolam group and propofol group were longer than that of remimafluma group［(10.0±3.5), (5.3±1.8)min vs (2.0±0.7)min］(both P<0.05), and that of remimazolam group was longer than that of propofol group (P<0.05). The mean arterial pressure, heart rate and pulse oxygen saturation of the remimazolam group and remimafluma group during cervical dilatation and intrauterine operation were higher than those of the propofol group (all P<0.05). There were no statistically significant differences in mean arterial pressure, heart rate and pulse oxygen saturation before induction and at extubation among the three groups (all P>0.05). The incidences of injection pain and intraoperative respiratory depression of remimazolam group and remimafluma group were lower than those of propofol group, and the differences were statistically significant (all P<0.05). There were no significant differences in other adverse reactions among the three groups during the perioperative period (all P>0.05). There was no intraoperative awareness and postoperative respiratory depression in the three groups. Conclusion Compared with the equivalent dose of propofol, remimazolam has a lower incidence of respiratory depression and more stable hemodynamics in patients undergoing hysteroscopic surgery under intravenous anesthesia with spontaneous breathing with nasopharyngeal airway retention. Flumazenil, a specific antagonist, can significantly shorten the recovery time, which is beneficial to the rapid recovery of patients undergoing hysteroscopic surgery.