[1]张国强**吴海滨欧键莹黎广祥赵春江.肺保护通气策略下瑞马唑仑对老年患者腹腔镜上腹部手术的肺保护效果[J].中国微创外科杂志,2025,01(6):342-347.
　Zhang Guoqiang,Wu Haibin,Ou Jianying,et al.Lung Protection Effect of Remazolam Under Lung Protective Ventilation Strategy in Elderly Patients Undergoing Laparoscopic Upper Abdominal Surgery[J].Chinese Journal of Minimally Invasive Surgery,2025,01(6):342-347.
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肺保护通气策略下瑞马唑仑对老年患者腹腔镜上腹部手术的肺保护效果()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年6期
页码:
342-347
栏目:
临床论著
出版日期:
2025-06-25

文章信息/Info

Title:
Lung Protection Effect of Remazolam Under Lung Protective Ventilation Strategy in Elderly Patients Undergoing Laparoscopic Upper Abdominal Surgery
作者:
张国强**吴海滨欧键莹黎广祥赵春江
(广东省佛山市南海区第四人民医院麻醉科，佛山528211)
Author(s):
Zhang Guoqiang;  Wu Haibin;  Ou Jianying;  et al.
Department of Anesthesiology, Fourth People’s Hospital of Nanhai District, Foshan 528211, China
关键词:
肺保护通气策略; 瑞马唑仑; 丙泊酚; 老年患者; 腹腔镜上腹部手术
Keywords:
Lung protection ventilation strategy; Remazolam; Propofol; Elderly patient; Laparoscopic upper abdominal surgery
文献标志码:
A
摘要:
目的探讨肺保护通气策略下瑞马唑仑对老年患者腹腔镜上腹部手术的肺保护效果。方法采用前瞻性随机对照研究，选取2023年10月~2024年10月拟行腹腔镜胆囊切除术、胆总管切开取石术、肝叶部分切除术、胃大部分切除术的年龄≥60岁患者60例作为研究对象，采用随机数字表法分为2组，观察组30例采用肺保护性通气策略+瑞马唑仑，对照组30例采用肺保护性通气策略+丙泊酚，比较2组炎症因子［肿瘤坏死因子α(TNFα)、白介素6(IL6)、超敏C反应蛋白(hsCRP)］，应激反应指标［超氧化物歧化酶(SOD)、去甲肾上腺素(NE)、皮质醇(Cor)］，麻醉质量［疼痛视觉模拟评分(VAS)、Ramsay评分］，肺功能［用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大通气量占预计值百分比(MVV%)］，血气指标［pH值、乳酸(Lac)、动脉血氧分压(PaO2)、动脉血CO2分压(PaCO2)］，苏醒质量(气管导管拔管时间、呼吸恢复时间、苏醒时间)及肺部并发症。结果观察组术后2、12、24 h血清炎症因子TNFα、IL6、hsCRP水平均低于对照组(均P=0000)。应激反应指标中，观察组术后2、12、24 h血清SOD水平均高于对照组，NE、Cor水平均低于对照组(均P=0.000)。观察组术后24 h VAS评分和术后2、24 h Ramsay评分均低于对照组(均P=0.000)。观察组术后48 h FVC、FEV1、MVV%均高于对照组(P<0.05)。观察组术后24 h PaO2高于对照组，Lac低于对照组(P<0.05)。观察组呼吸恢复时间、苏醒时间均短于对照组(P<0.05)，2组气管导管拔管时间、肺部并发症发生率差异无显著性(P>0.05)。结论肺保护通气策略下瑞马唑仑对老年患者腹腔镜上腹部手术的肺保护效果优于丙泊酚，可能通过减轻围术期应激反应、改善氧合功能、有效镇静、降低炎症反应发挥肺保护作用。
Abstract:
ObjectiveTo investigate the lung protection effect of remazolam under lung protection ventilation strategy in elderly patients undergoing laparoscopic upper abdominal surgery.MethodsA prospective randomized controlled study was conducted on 60 patients aged 60 years or older who were scheduled to undergo laparoscopic upper abdominal surgery, including cholecystectomy, common bile duct choledocholithotomy, partial hepatectomy, and subtotal gastrectomy from October 2023 to October 2024. The patients were divided into 2 groups by random number table method: 30 patients in the observation group received lung protective ventilation strategy and remazolam administration, and 30 patients in the control group received lung protective ventilation strategy and propofol administration. The inflammatory response indexes (TNFα, IL6, and hsCRP), stress indexes (SOD, NE, and Cor), anesthesia quality (VAS score and Ramsay score), lung function (FVC, FEV1, and MVV%), blood gas indexes (pH, Lac, PaO2, and PaCO2), recovery quality (tracheal tube extubation time, respiratory recovery time, and awakening time), and pulmonary complications were compared between the two groups.ResultsIn the observation group, the serum levels of inflammatory markers of TNFα, IL6, and hsCRP at 2, 12, and 24 h postoperatively were all lower than those in the control group (all P=0000). Regarding stress response indicators, the serum SOD levels in the observation group were higher than those in the control group at 2, 12, and 24 h postoperatively, while the NE and Cor levels were lower (all P=0.000). The VAS scores at 24 h postoperatively, and the Ramsay scores at 2 and 24 h postoperatively in the observation group were lower than those in the control group (all P=0.000). In the observation group, the FVC, FEV1, and MVV% were all higher than those in the control group at 48 h postoperatively (P<005). The PaO2 level in the observation group was higher than that in the control group at 24 h postoperatively, and the Lac level was lower (P<0.05). The respiratory recovery time and awakening time in the observation group were both shorter than those in the control group (P<0.05). There were no significant differences between the two groups in extubation time and pulmonary complications (P>0.05).ConclusionsThe lung protection effect of remazolam under lung protection ventilation strategy is better than that of propofol in elderly patients undergoing laparoscopic upper abdominal surgery. The lung protective effects may be achieved by alleviating perioperative stress response, improving oxygenation function, effective sedation, and reducing inflammatory response.

参考文献/References:

[1]杨继光,金沐,吕宝胜,等.二氧化碳气腹对颈动脉峰流速变异度预测腹腔镜结直肠手术患者容量反应性诊断阈值的影响.中国医药,2022,17(7):1042-1046.
[2]张京硕,金丽芳.不同二氧化碳气腹压对腹腔镜妇科手术病人动脉血气、血流动力学及应激状态的影响.蚌埠医学院学报,2021,46(11):1546-1550.
[3]邵先红,朱勃朗,王纯辉,等.瑞马唑仑联合艾司氯胺酮对剖宫产手术麻醉效果和精神症状的影响.临床麻醉学杂志,2024,40(7):719-722.
[4]林佳漫,叶咏欣,李尚航,等.瑞马唑仑快通道麻醉在改善心脏瓣膜手术患者术后恢复的作用.实用医学杂志,2024,40(14):1988-1994.
[5]中国老年医学学会麻醉学分会.老年患者术后肺部并发症防治专家共识.中华临床医师杂志(电子版),2023,17(1):7-22.
[6]Hirabayashi G,Saito M,Terayama S,et al.Lungprotective properties of expiratory flowinitiated pressurecontrolled inverse ratio ventilation:a randomised controlled trial.PLoS One,2020,15(12):e0243971.
[7]刘静,孟志鹏,颜伟,等.肺保护性通气策略对腹腔镜胃癌根治手术老年患者肺氧合功能及术后肺部并发症的影响.临床麻醉学杂志,2019,35(4):344-347.
[8]张林锋,郭志佳,王春燕,等.不同镇静深度下瑞马唑仑对区域麻醉患者外显记忆和内隐记忆的影响.临床麻醉学杂志,2023,39(7):695-699.
[9]陈功,卢彦西,李津,等.瑞马唑仑用于病态肥胖患者全身麻醉的有效性和安全性. 中国药理学通报,2024,40(5):859-864.
[10]段怡,王晓宇,高志峰,等.瑞马唑仑用于老年患者椎管内麻醉程序性镇静的半数有效剂量.临床麻醉学杂志,2023,39(1):34-38.
[11]Granger KT,Barnett JH.Postoperative cognitive dysfunction: an acute approach for the development of novel treatments for neuroinflammation.Drug Discov Today,2021,26(5):1111-1114.
[12]Ackenbom MF,Butters MA,Davis EM,et al.Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery.Int Urogynecol J,2021,32(2):433-442.
[13]肖暨艳,邝鹰,赖一民,等.肺保护性通气联合静吸复合麻醉对胸外科手术患者氧化应激反应、T淋巴细胞亚群及血清血小板活化因子、γ干扰素水平的影响.广西医学,2022,44(16):1821-1826.
[14]李海,李俊峰,于晖,等.肺保护性通气策略在全身麻醉患者经后腹膜腹腔镜手术中的应用.中国医刊,2021,56(1):61-64.
[15]王洪,杨尹.丙泊酚复合氟比洛芬酯麻醉对UniVATS术中单肺通气患者的肺功能保护作用观察.中国药师,2020,23(9):1788-1791,1825.
[16]张圣岸,曾宾,王盛标,等.肺保护性通气对全身麻醉手术合并慢性阻塞性肺疾病患者围术期肺部感染影响.创伤与急危重病医学,2019,7(1):37-38.

备注/Memo

备注/Memo:
基金项目：佛山市自筹经费类科技创新项目(2220001005286)**通讯作者，Email：85241788@qq.com
更新日期/Last Update: 2025-08-20