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论著·临床研究 | 更新时间:2026-09-07
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瑞马唑仑快通道麻醉对心脏瓣膜手术患者术中血流动力学和术后恢复的影响
Effects of remimazolam fast⁃track anesthesia on intraoperative hemodynamics and postoperative recovery in patients receiving cardiac valve surgery

广西医学 页码:1162-1167

作者机构:李星宇,硕士,住院医师,研究方向为临床麻醉与疼痛诊疗。

基金信息:江苏省卫生健康委员会科研项目(ZD2022001)

DOI:10.11675/j.issn.0253⁃4304.2026.08.10

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  • 参考文献

目的 探讨瑞马唑仑快通道麻醉对心脏瓣膜手术患者术中血流动力学及术后恢复的影响。方法 选取102例心脏瓣膜手术患者作为研究对象,随机分为对照组和观察组,每组51例,分别给予以丙泊酚为主的复合麻醉、以瑞马唑仑为基础的快通道麻醉。比较两组患者的血流动力学指标、心肌损伤标志物、早期恢复参数、神经功能恢复指标、术后恢复质量及术后并发症的发生情况。结果 围手术期,两组患者的心率、平均动脉压(MAP)、生活质量恢复15(QoR⁃15)量表总分均有随时间先下降再上升的趋势(P<0.05);麻醉诱导后,观察组的MAP高于对照组(P<0.05);气管插管后,观察组的心率低于对照组,MAP高于对照组(P<0.05);手术开始后5 min,观察组的心率及MAP均低于对照组(P<0.05);出院前1 d,观察组的QoR⁃15量表总分高于对照组(P<0.05)。术后24 h,两组患者的血清心肌肌钙蛋白I、肌酸激酶同工酶、心型脂肪酸结合蛋白水平均高于麻醉前,且观察组的上述指标均低于对照组(P<0.05)。两组患者机械通气时间比较,差异无统计学意义(P>0.05);观察组的ICU停留时间、术后住院时长、定向力恢复时间、自主呼吸恢复时间及术后拔除气管插管的时间均短于对照组(P<0.05)。两组患者的术后并发症发生率比较,差异无统计学意义(P>0.05)。结论 瑞马唑仑快通道麻醉可稳定心脏瓣膜手术患者的术中血流动力学,促进术后恢复,减轻心肌损伤,安全性良好。

Objective To investigate the effects of remimazolam fast⁃track anesthesia on intraoperative hemodynamics and postoperative recovery in patients receiving cardiac valve surgery. Methods A total of 102 patients receiving cardiac valve surgery were enrolled as the research subjects, and they were randomly divided into control group or observation group, with 51 cases in each group. Combined anesthesia mainly containing propofol, and fast⁃track anesthesia based on remimazolam were given to the two groups, respectively. Hemodynamic parameters, myocardial injury biomarkers, early recovery variables, neurological function recovery indicators, postoperative recovery quality, and the occurrence status of postoperative complications were compared between the two groups. Results Heart rate, mean arterial pressure (MAP), and total scores of Quality of Recovery 15 (QoR⁃15) scale in both groups exhibited a trend of initial decrease followed by an increase over time (P<0.05). After anesthesia induction, MAP was higher in the observation group than in the control group (P<0.05). After tracheal intubation, heart rate was lower and MAP was higher in the observation group than in the control group (P<0.05). Five minutes after the beginning of surgery, the observation group yielded a lower heart rate and MAP as compared with the control group (P<0.05). One day before discharge, the total QoR⁃15 scale score was higher in the observation group than in the control group (P<0.05). At 24 hours postoperatively, serum levels of cardiac troponin I , creatine kinase⁃MB, and heart⁃type fatty acid⁃binding protein were elevated compared with pre⁃anesthesia levels in both groups, and these biomarkers were lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in mechanical ventilation duration between the two groups (P>0.05). However, the length of ICU stay, postoperative length of hospital stay, time to orientation recovery, time to spontaneous breathing recovery, and time to postoperative tracheal extubation were all shorter in the observation group than in the control group (P<0.05). The incidence rate of postoperative complications interpreted no statistically significant difference between the two groups (P>0.05). Conclusion Remimazolam fast⁃track anesthesia stabilizes intraoperative hemodynamics, promotes postoperative recovery, and attenuates myocardial injury in patients undergoing cardiac valve surgery, with a favorable safety profile.

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