【罂粟摘要】瑞马唑仑和靶控丙泊酚麻醉诱导时中老年人的血流动力学比较：单中心，随机，对照试验

瑞马唑仑和靶控丙泊酚麻醉诱导时中老年人的血流动力学比较：单中心，随机，对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：文春雷  编辑：柏雪   审校：曹莹

背景：瑞马唑仑的低血压风险低于丙泊酚。然而，没有研究比较瑞马唑仑和靶控输注丙泊酚的疗效。本研究旨在探讨瑞马唑仑和靶控输注丙泊酚对麻醉诱导过程中的中老年患者血流动力学的影响。

方法: 40名年龄45-80岁，ASA分级Ⅰ~Ⅱ，被随机分配到瑞马唑仑组或丙泊酚组（每组n=20）。患者接受瑞马唑仑（12 mg/kg/h）或丙泊酚（3μg/mL，TCI）以及联合瑞芬太尼麻醉诱导。我们记录了患者血压，心率（HR）并使用脉搏波传输时间估计连续心输出量（esCCO）。主要结局指标是诱导后平均动脉压（MAP）的最大变化。次要结局指标包括HR，心输出量（CO）和每搏输出量的变化（SV）。

结果：两组麻醉诱导后MAP均下降，两组间差异无统计学意义(瑞马唑仑组为- 41.1[16.4]mmHg和丙泊酚组为-42.8[10.8]mmHg；平均偏差：1.7[95%置信区间： - 8.2—4.9]；p = 0.613）。此外，两组诱导后HR，CO和SV均下降，两组之间无显著差异。瑞马唑仑组意识消失的时间明显短于丙泊酚组（分别为1.7[0.7]min和3.5[1.7]min；p < 0.001）。然而，MAP、HR、CO和SV在各组之间没有显著差异。瑞马唑仑组和丙泊酚组分别有7例（35%）和11例（55%）患者出现低血压（MAP < 65 mmHg超过2.5 min），两组之间无显著差异（p = 0.341）。

结论：在麻醉诱导期间，瑞马唑仑和靶控丙泊酚组的血流动力学无显著差异。因此，不仅麻醉药的选择，而且麻醉药的剂量和使用对诱导麻醉时血流动力学的稳定性都很重要。临床医生应在用瑞马唑仑和丙泊酚诱导麻醉时监测低血压。

原始文献来源：Ryo Sekiguchi, Michiko Kinoshita , Ryosuke Kawanishi et al.Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial.[J]. BMC Anesthesiol (2023)23:14. 

英文原文：

Comparison of hemodynamics

during induction of general anesthesia

with remimazolam and target-controlled

propofol in middle-aged and elderly patients:

a single-center, randomized, controlled trial

BACKGROUND: Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia.

METHODS: Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n=20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV).

RESULTS: MAP decreased after induction of anesthesia in both groups, without signifcant differences between the groups (−41.1 [16.4] mmHg and−42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confdence interval:−8.2 to 4.9]; p=0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without signifcant differences between the groups. Remimazolam group had signifcantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p<0.001). However, MAP, HR, CO, and SV were not signifcantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP<65 mmHg over 2.5 min), without signifcant differences between the groups (p=0.341).

CONCLUSIONS: Hemodynamics were not signifcantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol.

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