2025 年第 5 期 第 20 卷

瑞马唑仑对甲状腺癌根治术患者围手术期应激反应及血流动力学的影响

The effects of remimazolam on perioperative stress response and hemodynamics in patients undergoing radical resection of thyroid cancer

作者：岳惠玉1白文娟2王敏2党莎杰1

英文作者：Yue Huiyu1 Bai Wenjuan2 Wang Min2 Dang Shajie1

单位：1陕西省肿瘤医院麻醉科，西安710043；2延安大学附属医院麻醉科，延安716000

英文单位：1Department of Anesthesiology Shaanxi Provincial Cancer Hospital Xi′an 710043 China; 2Department of Anesthesiology Yan′an University Affiliated Hospital Yan′an 716000 China

关键词：甲状腺癌；瑞马唑仑；应激反应；麻醉质量；血流动力学

英文关键词：Thyroidcancer;Remimazolam;Stressresponse;Qualityofanesthesia;Hemodynamics

• 摘要：

• 目的 观察瑞马唑仑对甲状腺癌根治术患者围手术期应激反应与血流动力学的影响。方法 选择2023年12月至2024年5月于陕西省肿瘤医院择期行根治术治疗的102例甲状腺癌患者，使用随机数字表法分成对照组与观察组，各51例，分别予以丙泊酚、瑞马唑仑麻醉。分析2组应激反应、血流动力学、术中状况、镇静效果及不良反应发生情况。结果 插管时、切皮时及术毕观察组肾上腺皮质激素、皮质醇水平均低于对照组［肾上腺皮质激素：（41.6±7.3）ng/L比（51.2±9.2）ng/L、（81.0±10.3）ng/L比（90.1±12.3）ng/L、（66.1±11.1）ng/L比（74.1±10.2）ng/L；皮质醇：（268±51）nmol/L比（338±66）nmol/L、（319±60）nmol/L比（401±72）nmol/L、（291±62）nmol/L比（364±70）nmol/L］，差异均有统计学意义（均P＜0.05）。与入室时比较，气管插管后即刻至手术结束时2组心率、平均动脉压及脉搏血氧饱和度均下降，且在气管插管后即刻，观察组心率、平均动脉压及脉搏血氧饱和度均高于对照组，差异均有统计学意义（均P＜0.05）。2组手术时间及不同时点改良警觉/镇静评分比较差异均无统计学意义（均P＞0.05）。观察组拔管时间、麻醉后监测治疗室停留时间及苏醒时间均短于对照组，差异均有统计学意义（均P＜0.05）。2组不良反应总发生率比较差异无统计学意义（χ2=0.684，P=0.408）。结论 瑞马唑仑在甲状腺癌根治术患者中应用效果较好，与丙泊酚相比血流动力学更加稳定，可减轻围手术期应激反应，且不会影响麻醉恢复。

• Objective To observe the effects of remimazolam on perioperative stress response and hemodynamics in patients undergoing radical resection of thyroid cancer. Methods A total of 102 patients with thyroid cancer who underwent elective radical resection in Shaanxi Provincial Cancer Hospital from December 2023 to May 2024 were selected. The patients were divided into control group and observation group by random number table method, with 51 cases in each group, and were given propofol and remimazolam anesthesia respectively. The stress response, hemodynamics, intraoperative status, sedation effect and adverse reactions of the two groups were analyzed. Results The levels of adrenocortical hormone and cortisol in the observation group were lower than those in the control group at the time of intubation, skin incision and the end of operation［adrenal cortex hormones:(41.6±7.3)ng/L vs (51.2±9.2)ng/L, (81.0±10.3)ng/L vs (90.1±12.3)ng/L, (66.1±11.1)ng/L vs (74.1±10.2)ng/L; cortisol:(268±51)nmol/L vs (338±66)nmol/L, (319±60)nmol/L vs (401±72)nmol/L, (291±62)nmol/L vs (364±70)nmol/L］(all P<0.05). Compared with the time when entering the room, the heart rate, mean arterial pressure and pulse oxygen saturation of the two groups decreased from immediately after tracheal intubation to the end of the operation, and the heart rate, mean arterial pressure and pulse oxygen saturation of the observation group were higher than those of the control group immediately after tracheal intubation(all P<0.05). There was no significant difference in operation time and modified vigilance/sedation score at different time points between the two groups(all P>0.05). The extubation time, stay time in post-anesthesia monitoring treatment room and recovery time of the observation group were shorter than those of the control group(all P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(χ2=0.684， P=0.408). Conclusion Remimazolam has a good application effect in patients undergoing radical resection of thyroid cancer. Compared with propofol, remimazolam is more hemodynamic stable, can reduce the perioperative stress response, and will not affect the recovery from anesthesia.