瑞马唑仑和右美托咪定对功能性内窥镜鼻窦手术后恢复质量的影响比较：一项随机临床试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
术后疼痛通常发生在接受功能性内镜鼻窦手术（FESS）的患者中。瑞马唑仑和右美托咪定可以提高术后恢复质量（QoR）。本研究旨在比较瑞马唑仑和右美托咪定对接受FESS患者的QoR-40评分的影响。
方法
共纳入120名（年龄18至65岁）计划接受FESS手术的患者，随机分配为R组、D组或C组。R组接受0.075mg/Kg瑞马唑仑负荷剂量和0.1mg/Kg/h输注。D组接受右美托咪定（负荷剂量1.0µg/Kg，输注速率为0.5µg/Kg/h）。C组接受与右美托咪定等效的安慰剂。麻醉诱导使用丙泊酚、舒芬太尼和顺式阿曲库铵。麻醉维持通过靶控输注（TCI）进行，输注药物为丙泊酚和瑞芬太尼。主要结局指标是术前一天及术后第1天（POD1）的QoR-40评分。次要结局指标包括恢复意识的时间、PACU的停留时间、到达PACU时的镇静评分、疼痛、术后恶心呕吐（PONV）以及丙泊酚和瑞芬太尼的累积用量。不良反应均被记录。
结果
POD1时的总QoR-40评分（中位数，IQR)：R组（154.5,152.0-159.0）和D组（155.0,154.8 -159.3）下降幅度较C组（139.0,136.8 -142.0）小。R组和C组意识恢复的时间和在PACU的停留时间显著短于D组（P<0.001）。R组（-2.0，-2.0—-1.0）和D组（-2.0，-3.0—-2.0）到达PACU时的镇静水平（中位数，IQR）高于C组（1.0,0.0 -1.0）（P<0.001）。R组和D组的丙泊酚和瑞芬太尼累积消耗率低于C组（P<0.001）。与C组相比，R组和D组的疼痛强度较低（P<0.001）。R组（3/40）和D组（4/40）发生PONV的患者数量少于C组（11/40）（P=0.024）。D组有15名患者出现心动过缓，而R组和C组均未见心动过缓（P<0.001）。
瑞马唑仑的给药可以提供与右美托咪定相似的QoR评分，此外，瑞马唑仑可能是改善FESS患者QoR评分的一个有希望的选择。
原始文献：Yaqiong, Li., Hui, Zhou., Fanfan, Gao., Qianqian, Guan., Shengbin, Wang., Yvqing, Tan., Shenghong, Hu.(2024). Comparison of the effects of remimazolam and dexmedetomidine on the quality of recovery in functional endoscopic sinus surgery: a randomized clinical trial. BMC Anesthesiol, 24(1), 0.doi:10.1186/s12871-024-02860-8
Comparison of the efects of remimazolam and dexmedetomidine on the quality of recovery in functional endoscopic sinus surgery: a randomized clinical trial
Abstract
Background Postoperative pain usually occur in patients who have
undergone functional endoscopic sinus surgery (FESS). Remimazolam and dexmedetomidine could enhance the quality of recovery (QoR) after surgery. The aim of this study was to compare the efects of remimazolam and dexmedetomidine with respect to the QoR-40 score of patients who have undergone FESS.
Methods A total of 120 patients (18–65 years) scheduled for FESS were randomly allocated to Group R, Group D or Group C. Group R received 0.075 mg/kg remimazolam loading and 0.1 mg/kg/h infusion. Group D received dexmedetomidine (1.0 µg/kg loading, 0.5 µg/kg/h infusion). Group C received a placebo equal to dexmedetomidine. Anaesthesia was induced with propofol, sufentanil and cisatracurium. Anaesthesia maintenance was performed via target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome was the QoR-40 score
on the day before surgery and postoperative Day 1 (POD1). The
secondary outcomes were the time to return to consciousness, length of stay in the PACU, sedation score upon PACU arrival, pain,postoperative nausea and vomiting (PONV) and cumulative consumption of propofol and remifentanil. Adverse efects were recorded.
Results The total QoR-40 scores (median, IQR) on POD1 decreased less (154.5, 152.0 -159.0) in Groups R and D (155.0, 154.8 -159.3) than in Group C (139.0, 136.8 -142.0) (P<0.001). The time to return of consciousness and the length of stay in the PACU were signifcantly shorter in Groups R and C than in Group D (P<0.001). The level of sedation upon PACU arrival (median, IQR) in Groups R (-2.0, -2.0—-1.0) and D (-2.0, -3.0—-2.0) was greater than that in Group C (1.0, 0.0 -1.0) (P<0.001). The cumulative consumption rates of propofol and remifentanil in Groups R and D were lower than that in Group C (P<0.001). Compared with that in Group C, the pain intensity was lower in Groups R and D (P<0.001).The number of patients occurring PONV was less in Groups R (3/40) and D (4/40) than in Group C (11/40) (P=0.024). Fifteen patients had bradycardia in Group D, whereas no bradycardia was noted in Groups R or C (P<0.001).
Conclusion Administration of remimazolam could provide a similar QoR to that of dexmedetomidine. In addition, remimazolam may be a promising option for improving the QoR of patients who have undergone FESS.