2025 年第 8 期 第 20 卷

瑞马唑仑对单肺通气老年患者应激反应和炎性因子及术后短期恢复质量的影响

The effects of remimazolam on stress response, inflammatory factors and postoperative short-term quality of recovery in elderly patients undergoing one-lung ventilation

作者：袁莉1龚洁1朱莹1焦丽萍2闫亚男3李国利1滕金亮1

英文作者：Yuan Li1 Gong Jie1 Zhu Ying1 Jiao Liping2 Yan Yanan3 Li Guoli1 Teng Jinliang1

单位：1河北北方学院附属第一医院麻醉科，张家口075000；2河北北方学院附属第一医院供应室，张家口075000；3河北北方学院附属第一医院手术室，张家口075000

英文单位：1Department of Anesthesiology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 2Supply Room the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 3Operating Room the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：单肺通气；瑞马唑仑；应激反应；炎性因子；恢复质量

英文关键词：One-lungventilation;Remimazolam;Stressresponse;Inflammatoryfactors;Qualityofrecovery

• 摘要：

• 目的 观察瑞马唑仑对单肺通气老年患者应激反应、血清炎性因子及术后短期恢复质量的影响。方法 选取2023年8月至2024年8月于河北北方学院附属第一医院行胸腔镜肺癌根治手术患者60例。采用随机数字表法将患者分为P组和R组，各30例。P组给予丙泊酚+瑞芬太尼麻醉，R组给予瑞马唑仑+瑞芬太尼麻醉。监测记录麻醉前(T1)、插管(T2)、切皮(T3)、术毕(T4)、拔管(T5)5个时点的心率、平均动脉压（MAP）、血氧饱和度、脑电双频指数（BIS）。记录术中出现低血压、心动过缓、高血压及血管活性药使用情况；比较2组术前、术后24 h疼痛介质指标；于术前、术毕及术后6、24 h测定炎症介质及应激反应指标；分别于麻醉诱导前，术后24、72 h时记录患者15项恢复质量(QoR-15)量表评分。结果  R组T4时点心率和MAP均高于P组，T5时点BIS低于P组，差异均有统计学意义（均P＜0.05）。R组术中低血压、心动过缓发生率及血管活性药物使用率均低于P组［10.0%（3/30）比50.0%（15/30）、0（0）比26.6%（8/30）、26.6%（8/30）比83.3%（25/30）］（均P＜0.05）。术后24 h，2组高迁移率族蛋白B1水平均低于术前，且R组低于P组，2组前列腺素E2和5-羟色胺水平均高于术前，且R组均高于P组(均P＜0.05)。术毕即刻及术后6、24 h，2组C反应蛋白、白细胞介素6水平均高于术前，但R组各时点均低于P组（均P＜0.05）；术毕即刻、术后6 h，2组皮质醇水平均高于术前，但R组各时点均低于P组（均P＜0.05）。2组术后24、72 h QoR-15评分总分均低于麻醉诱导前，但R组均高于P组(均P＜0.05)。结论  瑞马唑仑对接受胸腔镜肺癌根治术的老年患者术中能维持血流动力学平稳，减少心血管不良事件的发生率，同时可抑制疼痛介质及炎性因子释放，利于减轻老年患者术后应激反应，术后恢复质量更高。

• Objective To observe the effects of remimazolam on stress response, serum inflammatory factors and postoperative short-term quality of recovery in elderly patients with one-lung ventilation. Methods Sixty patients who underwent thoracoscopic radical lung cancer surgery in the First Affiliated Hospital of Hebei North University from August 2023 to August 2024 were selected. The patients were divided into group P and group R according to the random number table method, with 30 cases in each group. Group P was given propofol and remifentanil anesthesia, group R was given remimazolam and remifentanil anesthesia. The heart rate, mean arterial pressure (MAP), blood oxygen saturation, and bispectral index (BIS) were monitored and recorded before anesthesia (T1), intubation (T2), skin incision (T3), at the end of operation (T4), and extubation (T5). The occurrence of hypotension, bradycardia, hypertension and the use of vasoactive drugs during operation were recorded. The pain mediators were compared between the two groups before operation and 24 h after operation. Inflammatory mediators and stress response indexes were measured before operation, at the end of operation, and at 6 and 24 h after operation. The quality of recovery 15-item (QoR-15) scale scores were recorded before induction of anesthesia and at 24 and 72 h after operation. Results The heart rate and MAP at T4 in group R were higher than those in group P, and BIS at T5 was lower than that in group P (all P<0.05). The incidence of hypotension, bradycardia and the use of vasoactive drugs in group R were lower than those in group P ［10.0%(3/30) vs 50.0%(15/30), 0 (0) vs 26.6%(8/30), 26.6%(8/30) vs 83.3%(25/30)］(all P<0.05). At 24 h after operation, the levels of high-mobility protein B1 protein in the two groups were lower than those before operation, and those in group R were lower than those in group P. The levels of prostaglandin E2 and 5-hydroxytryptamine in the two groups were higher than those before operation, and those in group R were higher than those in group P (all P<0.05). The levels of C-reactive protein and interleukin-6 in the two groups were higher than those before operation immediately after operation and at 6 and 24 h after operation, but those in group R were lower than those in group P at each time point (all P<0.05). The cortisol levels immediately after operation and 6 h after operation were higher than those before operation in both groups, but those in group R were lower than those in group P at each time point (all P<0.05). The total QoR-15 scores at 24 h and 72 h after operation were lower than those before anesthesia induction in both groups, but those in group R were higher than those in group P (all P<0.05).Conclusion Remimazolam can maintain hemodynamic stability and reduce the incidence of adverse cardiovascular events in elderly patients undergoing thoracoscopic radical resection of lung cancer. At the same time, it can inhibit the release of pain mediators and inflammatory factors, which is beneficial to reduce the postoperative stress response of elderly patients and improve the quality of postoperative recovery.