朱 珊,张艳梅,游 波,陈小红,曹汉忠.乳腺癌根治术全身麻醉中不同剂量瑞马唑仑的应用效果对比观察[J].转化医学杂志,2022,11(5):314-318
乳腺癌根治术全身麻醉中不同剂量瑞马唑仑的应用效果对比观察
Effect of Different Doses of Remifentanil Infusion during Induction of General Anesthesia for Radical Mastectomy of Breast Cancer
  
DOI:
中文关键词:  乳腺癌根治术  瑞马唑仑  麻醉
英文关键词:Radical mastectomy  Remimazolam  Anesthesia
基金项目:江苏省科技项目
作者单位
朱 珊 南通大学附属肿瘤医院麻醉科 
张艳梅 南通大学附属肿瘤医院麻醉科 
游 波 南通大学附属医院耳鼻咽喉头颈外科 
陈小红 南通大学附属肿瘤医院麻醉科 
曹汉忠 南通大学附属肿瘤医院麻醉科 
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中文摘要:
      目的 探讨不同剂量瑞马唑仑对乳腺癌根治术全身麻醉的应用效果。方法 选择2021年10月-2022年6月在南通大学附属肿瘤医院行乳腺癌根治术的126例患者进行研究,采用随机数字表法分为对照组(n=20),A组(n=36),B组(n=35)和C组(n=35)。所有患者均进行全麻,对照、A、B、C组分别静注瑞马唑仑0、0.2、0.3、0.4 mg/kg进行麻醉诱导,四组均静脉注射苯磺顺阿曲库铵0.2 mg/kg、地佐辛注射液10mg和盐酸羟考酮注射液10 mg。维持期给予瑞马唑仑0.3~1.2 mg/(kg·h)和瑞芬太尼6~12 μg/(kg·h),并根据麻醉深度调整剂量。①观察四组患者麻醉效果相关指标,包括麻醉起效时间、苏醒时间、拔管时间、麻醉后监测治疗室(post-anesthesia care unit,PACU)滞留时间、瑞马唑仑补救率。②比较四组患者诱导开始前(T0)、初次脑电双频指数(bispectral index,BIS)值≤60时(T1)、气管插管后(T2)、手术开始30 min时(T3)、手术结束时(T4)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和心率(heart rate,HR)。④记录不良反应发生情况。结果 B组麻醉起效时间、术中瑞马唑仑补救率低于对照组和A组,苏醒时间、PACU滞留时间高于对照组和A组(P<0.05),组间拔管时间比较无明显差异(P>0.05)。B组苏醒时间、拔管时间、PACU滞留时间低于C组(P<0.05),麻醉起效时间高于C组(P<0.05);T0~T4时三组收缩压、舒张压和心率比较无明显差异(P>0.05)。各组T1时刻的心率均高于T0、T3和T4(P<0.05),与T2时刻相比无明显差异(P>0.05);各组T1~T4时的收缩压和舒张压均小于T0(P<0.05)。C组不良反应总发生率高于对照组、A组和B组(P<0.05),但对照组、A组和B组之间比较差异无统计学意义(P>0.05)。结论 对乳腺癌根治术患者采用瑞马唑仑进行全身麻醉安全有效,相对于诱导剂量0、0.2、0.4 mg/kg,瑞马唑仑诱导剂量为0.3 mg/kg、维持剂量为0.3~1.2 mg/(kg·h)时,对乳腺癌根治术患者的麻醉效果最佳。
英文摘要:
      Objective To compare the effect of different doses of remifentanil infusion during induction of general anesthesia for radical mastectomy of breast cancer. Methods One hundred and six patients underwent radical mastectomy for breast cancer in Thyroid and Breast Surgery Department of our hospital from October 2021 to June 2022 were enrolled and devided into four groups via random number table method. All patients received remifentanil for the induction of general anesthesia, and the doses in gruop control(n=20), group A (n=36), group B (n=35) and group C (n=35) were 0 mg/kg, 0.2 mg/kg, 0.3 mg/kg and 0.4 mg/kg, respectively. All four groups were intravenously injected with cisatracurium 0.2 mg/kg, dezocine injection 10 mg and oxycodone hydrochloride injection 10 mg. During the maintenance period, remimazolam 0.3-1.2 mg/(kg·h) and remifentanil 6-12 μg/(kg·h) were administered. The depth of anesthesia was adjusted to maintain a bispectral index (BIS) of 40~60. The anesthesia effect related parameters including anesthesia onset time, recovery time, extubation time, discharge time from the post-anesthesia care unit (PACU), and intraoperative remimazolam rate were compared between the four groups, and comparison was also conducted on systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) before induction initiation (T0), at initial BIS value ≤ 60 (T1), after tracheal intubation (T2), at 30 min from the start of surgery (T3), and at the end of surgery (T4) in all three groups. The adverse reactions were also recorded. Results Compared with group control and group A, the group B had shorter anesthesia onset time, lower intraoperative remimazolam rate, prolonged anesthesia recovery time, and discharge time from PACU (all P<0.05), while the extubation time yielded no statistical difference among group control, group A and B (P>0.05). The recovery time, extubation time, and discharge time from PACU in the group B were shorter than those in the group C (P<0.05), and the onset time of anesthesia was longer than that in the group C (P<0.05). SBP, DBP and HR at T0~T4 demonstrated no difference among the four groups (P>0.05). HR at T1 in each group was higher than that at T0, T3 and T4 (P<0.05), while there was no difference at T2 (P>0.05). SBP and DBP at T1-T4 in each group were lower than those at T0 (P<0.05). The overall adverse reaction rate in the group C was the highest among the four groups (P<0.05), while the group control, group A and B denoted no difference (P>0.05). Conclusion Remimazolam is safe and effective for general anesthesia in patients undergoing radical mastectomy for breast cancer. Compared with the induction dose of 0mg/kg 0.2 mg/kg and 0.4 mg/kg, the induction dose of 0.3 mg/kg and maintenance dose of 0.3-1.2 mg/ (kg·h) of remimazolam achieve the best anesthesia effect on patients undergoing radical mastectomy.
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