【罂粟摘要】肝硬化患者行内镜下食管静脉曲张结扎术中使用瑞马唑仑和丙泊酚全身麻醉的有效性和安全性的比较

贵州医科大学     麻醉与心脏电生理课题组

翻译：吴学艳  编辑：陈锐  审核：曹莹

罂 粟 摘 要   

背景:肝硬化患者接受内镜下食管静脉曲张结扎术(EVL)的最佳候选静脉麻醉药物仍不清楚；瑞马唑仑(RT)是一种具有起效快、恢复快、无积累的新型苯二氮卓类药物。在这里，我们研究了RT用于肝硬化患者行EVL全身麻醉中的有效性和安全性。

方法:将择期行EVL的患者随机分为瑞马唑仑组(R组)和丙泊酚组(P组)；RT以0.2 mg/kg缓慢给药诱导，随后以1.0～2.0 mg/kg/h维持全身麻醉；丙泊酚以2 mg/kg诱导，以4～10 mg/kg/h的速度维持至手术结束。R组术后常规给予氟马西尼拮抗，P组术后即刻给予等量生理盐水。比较RT与丙泊酚用于EVL全身麻醉的有效性和安全性。

结果:两组患者麻醉效果均满意，有效率均为100%；R组意识消失时间(LoC)长于P组(P>0.05)；R组意识恢复时间、拔管时间、出室时间均明显短于P组(P<0.05)。R组术中低血压和术后低SpO2的发生率低于P组(P<0.05)；两组患者及术者满意度比较差异均无统计学意义(P > 0.05)。

结论:瑞马唑仑可为EVL手术提供满意的麻醉效果；R组患者较P组患者苏醒快、PACU停留时间更短。此外，RT可降低低血压和低SpO2的发生率；与丙泊酚相比，RT为肝硬化患者行EVL全身麻醉更安全、更有效的选择。

原始文献来源：

Shi F, Chen Y, Li H, et al. Efficacy and Safety of Remimazolam

Tosilate versus Propofol for General Anesthesia in Cirrhotic Patients Undergoing

Endoscopic Variceal Ligation[J]. Int J Gen Med. 2022 Jan 13;15:583-591. DOI:

10.2147/IJGM.S345390. PMID: 35046716; PMCID: PMC8763269.

英文原文

Efficacy and Safety of Remimazolam Tosilate versus Propofol for General Anesthesia in Cirrhotic Patients Undergoing Endoscopic Variceal Ligation

Abstract

Introduction: The best candidate intravenous anesthetic agent for patients with liver cirrhosis undergoing endoscopic variceal ligation (EVL) remains unclear. Remimazolam tosilate (RT) is a new type of benzodiazepine with quick onset, rapid recovery, and no accumulation. Here, we investigated the efficacy and safety of RT for general anesthesia in cirrhotic patients undergoing EVL.

Methods: Patients undergoing EVL were randomly classified into the remimazolam tosilate (group R) and the propofol group (group P). RT was administered as a slow bolus of 0.2 mg/kg for induction and followed by 1.0-2.0 mg/kg/h for maintenance of general anesthesia. Propofol was started at 2 mg/kg, followed by 4-10 mg/kg/h until the end of surgery. Flumazenil was routinely administered to group R and the same volume of saline was given to group P immediately after surgery. The efficacy and safety of RT for general anesthesia during EVL were compared with propofol.

Results: All patients in the two groups had satisfactory anesthetic effects and the efficacy rates were 100%. The time to loss of consciousness (LoC) was longer in group R than in group P (P > 0.05). The return of consciousness (RoC) time, extubation time, and transfer time in group R were significantly shorter than that in group P (P < 0.05). The incidence of intraoperative hypotension and postoperative low SpO2 in group R were lower than that in the group P (P < 0.05). There were no significant differences between the two groups with respect to the satisfaction degree of patients and operators (P > 0.05).

Conclusion: Remimazolam tosilate can provide satisfactory anesthetic effects for surgery. Group R patients recovered faster and had a shorter PACU stay time than group P patients. Moreover, RT decreased the incidence of hypotension and low SpO2. RT was a safer and more effective alternative for general anesthesia in cirrhotic patients undergoing EVL than propofol.   

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