瑞马唑仑全身麻醉对妇科腹腔镜手术患者核心体温和体温调节性血管收缩的影响

Remimazolam general anesthesia on the core body temperature of patients undergoing gynecological laparoscopic surgery and the effects of thermoregulatory vasoconstriction

摘要:

目的 探讨瑞马唑仑全身麻醉对妇科腹腔镜手术患者核心体温（CBT）和体温调节性血管收缩的影响。方法 选取2024年1月－2024年6月于该院择期在全身麻醉下行腹腔镜手术的宫颈癌或卵巢癌患者90例，随机分为实验组（R组）和对照组（C组），每组45例，分别用瑞马唑仑和丙泊酚行麻醉诱导和维持。麻醉诱导后，分别采用鼻咽温度探头和皮肤温度探头，持续监测鼻咽温度和皮肤温度；记录两组患者术前（T₀）、麻醉诱导后30 min（T₁）、麻醉诱导后60 min（T₂）、麻醉诱导后90 min（T₃）、麻醉诱导后120 min（T₄）、麻醉诱导后150 min（T₅）、麻醉诱导后180 min（T₆）和拔管时（T₇）的CBT和平均皮肤温度（MST），以及前臂与食指部位的温度差（T_FOR-FIN）。以T_FOR-FIN为0时的CBT作为血管收缩阈值，记录两组患者的血管收缩阈值及达到血管收缩阈值的时间；记录两组患者各时间点（T₀、T₁、T₂、T₃、T₄、T₅、T₆和T₇）的平均动脉压（MAP）、心率（HR）和心排血指数（CI）的变化；记录术中低体温、低血压和心动过缓的发生率，以及术中血管活性药的使用情况。结果 与T₀时点比较，两组患者T₁、T₂、T₃、T₄、T₅、T₆和T₇时点CBT和T_FOR-FIN明显下降，MST明显升高，差异均有统计学意义（P < 0.05）；与R组比较，C组T₁、T₂、T₃、T₄和T₅时点CBT明显降低，T₁、T₂、T₃、T₄、T₅、T₆和T₇时点MST明显升高，差异均有统计学意义（P < 0.05）。R组的血管收缩阈值明显高于C组，但达到血管收缩阈值的时间明显短于C组，差异均有统计学意义（P < 0.05）。与T₀时点比较，两组患者T₁、T₂、T₃时点MAP和CI明显降低，但R组T₁、T₂和T₃时间点MAP和CI明显高于C组，差异均有统计学意义（P < 0.05）；与R组比较，C组术中围手术期低体温（PH）和低血压的发生率，以及术中麻黄素使用率明显升高，差异均有统计学意义（P < 0.05）。结论 瑞马唑仑与丙泊酚用于妇科腹腔镜全身麻醉，均可引起患者术中体温下降，与丙泊酚比较，瑞马唑仑全身麻醉对CBT的影响更小，血流动力学更加平稳，对体温调节性血管收缩的影响更小，舒张血管程度更轻，具有更好的体温保护作用。

Abstract:

Objective To investigate the effect of remimazolam on core body temperature (CBT) and thermoregulatory vasoconstriction in patients undergoing gynecological laparoscopic surgery.Methods 90 gynaecology patients with ovarian or cervical cancer from Jan 2024 to Jun 2024 were randomly divided into experimental group (group R) and control group (group C). 45 patients in each group were induced and maintained with remimazolam or propofol. After induction of anesthesia, the CBT and mean skin temperature (MST) were continuously monitored using a nasopharyngeal temperature probe and a skin temperature probe respectively. Record CBT and MST of two groups of patients before surgery (T₀), 30 min (T₁), 60 min (T₂), 90 min (T₃), 120 min(T₄), 150 min (T₅), 180 min (T₆) after induction of anesthesia and at extubation (T₇), as well as forearm-fingertip temperature gradient (T_FOR-FIN). Record vasoconstriction threshold and time to onset of vasoconstriction by T_FOR-TIN. Record the changes in mean arterial pressure (MAP), heart rate (HR), and cardiac index (CI) at each time point (T₀, T₁, T₂, T₃, T₄,T₅, T₆ and T₇ time point); Record the incidence of hypothermia, hypotension and bradycardia and the use of vasoactive drugs.Results Compared with T₀ time point, the CBT and T_FOR-TIN at T₁ to T₇ time point decreased significantly, but the MST increased (P < 0.05); In group C, the CBT at T₁ to T₅ decreased significantly than in group R (P < 0.05); Compared with group C, MST in group R increased significantly at time T₁ to T₇ (P < 0.05). The vasoconstriction threshold in group R was significantly higher than that in group C, and the time to reach the vasoconstriction threshold was significantly less than that in group C (P < 0.05). Compared with T₀ time point, MAP and CI at T₁, T₂, T₃ time point decreased significantly in two groups, MAP and CI at T₁, T₂, T₃ time point in group R were higher than those in group C (P < 0.05); Compared with group R, the incidence of perioperative hypothermia (PH) and hypotension and the utilization rate of ephedirine in group C were increased (P < 0.05).Conclusion Remimazolam and propofol for gynecological laparoscopic general anesthesia can cause intraoperative temperature drop in patients, compared with propofol, remimazolam general anesthesia has less influence on CBT, more stable hemodynamics,less influence on thermoregulatory vasoconstriction, less degree of diastolic blood vessels, has better body temperature protection.