泌尿外科手术的患者使用瑞马唑仑或丙泊酚全身麻醉后的康复质量比较：一项随机对照试验

贵州医科大学     麻醉与心脏电生理课题组

翻 译：严旭   编 辑：柏雪    审 校：曹 莹

背景：瑞马唑仑是一种具有镇静和催眠作用的新药。事实证明在全身麻醉的疗效和安全性方面不低于丙泊酚。然而，就患者的康复质量而言，使用瑞马唑仑进行全身麻醉是否优于丙泊酚，目前还不得而知。

患者和方法：参加这项研究的患者被随机分为瑞马唑仑或丙泊酚组。在瑞马唑仑组中，用瑞马唑仑和舒芬太尼诱导全身麻醉，用瑞马唑仑和瑞芬太尼维持全身麻醉。在丙泊酚组中，用丙泊酚和舒芬太尼诱导全身麻醉，并用丙泊酚和瑞芬太尼维持。麻醉期间还使用了神经肌肉阻滞剂顺式阿曲库铵。通过脑电图双频指数（BIS）监测镇静水平。我们的主要观察结果是使用恢复质量-15（QoR-15）量表来提高患者术后恢复的质量。次要观察结果包括SpO2、HR、MBP和麻醉期间血管活性药物的应用频率，以及麻醉恢复室（PACU）的不良事件发生率。

结果：术后第1天和第3天瑞马唑仑组的QoR-15量表得分低于丙泊酚组，但两组之间的差异仅在术后第1天具有临床意义。在QoR-15量表的五个维度中，瑞马唑仑组的身体舒适度和情绪状态得分低于丙泊酚组。麻醉诱导后，瑞马唑仑组的MBP和HR高于丙泊酚组。SpO2在两组中相似。丙泊酚组麻醉期间使用血管活性药物的频率高于瑞马唑仑组。两组之间不良事件的发生率没有统计学差异。

结论：与丙泊酚相比，瑞马唑仑在全身麻醉中可以提供更稳定的血流动力学，但也会导致泌尿外科手术患者术后的康复质量暂时下降。

原始文献来源: Yuanyuan Mao, Jin Guo, Jingjing Yuan, Erxian Zhao, Jianjun Yang. Quality of Recovery After General Anesthesia with Remimazolam in Patients' Undergoing Urologic Surgery: A Randomized Controlled Trial Comparing Remimazolam with Propofol. 2022 Apr 27;16:1199-1209.

英文原文：

Quality of Recovery After General Anesthesia with Remimazolam in Patients' Undergoing Urologic Surgery: A Randomized Controlled Trial Comparing Remimazolam with Propofol

Abstract

Background: Remimazolam is a new medication with sedative and hypnotic effects. It has been demonstrated non-inferior to propofol in general anesthesia with regard to efficacy and safety. However, whether general anesthesia with remimazolam is better than propofol in terms of patients' recovery quality remains unknown.

Patients and methods: Patients enrolled in this study were randomized to remimazolam or propofol group. In remimazolam group, general anesthesia was induced with remimazolam and sufentanil and maintained with remimazolam and remifentanil. In propofol group, general anesthesia was induced with propofol and sufentanil and maintained with propofol and remifentanil. Neuromuscular blocking agent cisatracurium was also injected during anesthesia. Sedation level was monitored by bispectral index (BIS). Our primary outcome was the quality of patients' postoperative recovery, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included SpO2, HR, MBP and frequency of application of vasoactive drugs during anesthesia, as well as incidences of adverse events in the post anesthesia care unit (PACU).

Results: The global scores of QoR-15 scale were lower in remimazolam group at postoperative day 1 and day 3 compared to propofol group, but differences between the two groups only had clinical significance at postoperative day 1. Among the five dimensions of QoR-15 scale, scores for physical comfort and emotional state were lower in remimazolam group than propofol group. MBP and HR were higher in remimazolam group than propofol group after anesthesia induction. SpO2 was similar in the two groups. The frequency of application of vasoactive drugs during anesthesia was higher in propofol group than remimazolam group. There was no statistical difference in the incidences of adverse events between the two groups.

Conclusion: General anesthesia with remimazolam can provide more stable hemodynamics but also cause temporary reduction in the quality of recovery in patients undergoing urologic surgery, compared to propofol.

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