瑞马唑仑联合腹横肌平面阻滞麻醉在腹腔镜下结直肠癌根治术患者中的应用

Application of remimazolam combined with transversus abdominis plane block anesthesia in patients undergoing laparoscopic radical resection of colorectal cancer

摘要:

目的 探讨瑞马唑仑在腹腔镜下结直肠癌根治术患者腹横肌平面阻滞（TAPB）麻醉中的应用。方法 选取2023年1月－2025年1月于该院行腹腔镜下结直肠癌根治术的患者70例，采用随机数表法分为A组（TAPB麻醉，35例）和B组（苯磺酸瑞马唑仑+TAPB麻醉，35例），均观察至患者出院。比较两组围术期指标、血流动力学指标、免疫指标、应激指标、疼痛评分和简易精神状态量表（MMSE）评分。结果 与A组比较，B组首次排气时间、住院时间、下床活动时间、麻醉恢复室（PACU）停留时间和苏醒时间明显更短，差异均有统计学意义（P 0.05）。与麻醉前（T₁）比较，两组插管前即刻（T₂）、插管后1 min（T₃）和插管后3 min（T₄）的平均动脉压（MAP）、心率（HR）均降低，但B组明显高于A组，差异均有统计学意义（P 0.05）。与T₁时点比较，两组术毕时血清皮质醇（Cor）和去甲肾上腺素（NE）水平均升高，但B组明显低于A组，两组外周血CD3⁺、CD4⁺和CD8⁺水平均降低，且B组外周血CD8⁺水平明显低于A组，外周血CD3⁺和CD4⁺水平明显高于A组，差异均有统计学意义（P 0.05）。与T₁时点比较，术后12、24和48 h，两组视觉模拟评分法（VAS）评分呈先升高后降低趋势。其中，术后24和48 h，B组明显低于A组，差异均有统计学意义（P 0.05）。与术前24 h比较，两组术后24和72 h MMSE评分呈先降低后升高趋势，且B组明显高于A组，差异均有统计学意义（P 0.05）。结论 瑞马唑仑复合TAPB麻醉，对腹腔镜下结直肠癌根治术患者血流动力学的影响较小，可调节患者机体内免疫和应激反应指标，促进术后恢复，减轻患者疼痛感的同时，还可提高患者的认知水平。值得应用于临床。

Abstract:

Objective To explore the application of remimazolam in transversus abdominis plane block (TAPB) anesthesia for patients undergoing laparoscopic radical resection of colorectal cancer.Methods A total of 70 patients who underwent laparoscopic radical resection of colorectal cancer in this hospital from January 2023 to January 2025 were selected and divided into Group A (TAPB anesthesia, 35 cases) and Group B (remimazolam besylate + TAPB anesthesia, 35 cases) by random number table method. All patients were observed until discharge. The perioperative index, hemodynamic indicators, immune indicators, stress indicators, pain scores and mini mental state examination (MMSE) scores of the two groups were compared.Results Compared with Group A, Group B had shorter first exhaust time, hospital stay, time to get out of bed and move around, time to stay in the postanesthesia care unit (PACU), and recovery time, the differences were statistically significant (P 0.05). Compared with before anesthesia (T₁), the mean arterial pressure (MAP) and heart rate (HR) in both groups were decreased immediately before intubation (T₂), 1 minute after intubation (T₃), and 3 minutes after intubation (T₄), but group B was significantly higher than group A, and the differences were statistically significant (P 0.05). Compared with time point T1, the levels of serum cortisol (Cor) and norepinephrine (NE) at the end of the operation in both groups increased, but those in group B were significantly lower than those in group A. The levels of peripheral blood CD3⁺, CD4⁺ and CD8⁺ all decreased, but the level of peripheral blood CD8⁺ in group B was significantly lower than that in group A, and the levels of peripheral blood CD3⁺ and CD4⁺ were significantly higher than those in group A. The differences were all statistically significant (P 0.05). Compared with time point T₁, 12, 24 and 48 hours after the operation, the visual analogue scale (VAS) scores of the two groups showed a trend of first increasing and then decreasing. Among them, at 24 and 48 hours after the operation, group B was significantly lower than group A, and the differences were statistically significant (P 0.05). Compared with 24 hours before the operation, the MMSE scores of both groups showed a trend of first decreasing and then increasing 24 and 72 hours after the operation. However, the MMSE score of group B was significantly higher than that of group A, and the differences were statistically significant (P 0.05).Conclusion Remimazolam combined with TAPB anesthesia has a relatively small impact on the hemodynamics of patients undergoing laparoscopic radical resection of colorectal cancer. It can regulate the immune and stress response indicators in the patient's body, promote postoperative recovery, reduce the patient's pain, and at the same time improve the patient's cognitive level. It is worth applying in clinical practice.