瑞马唑仑联合艾司唑仑对腹腔镜手术前焦虑患者术后胃肠功能恢复的影响

Effects of remimazolam combined with estazolam on postoperative gastrointestinal function recovery in patients with anxiety before laparoscopic surgery

中文关键词: 术前焦虑  术后胃肠功能  瑞马唑仑  艾司唑仑

英文关键词: Preoperative anxiety  Postoperative gastrointestinal function  Remimazolam  Estazolam

中文摘要:

      
目的 探讨应用瑞马唑仑联合艾司唑仑缓解术前焦虑对腹腔镜胆囊切除术患者术后胃肠功能恢复的影响。

方法 选择择期行腹腔镜胆囊切除术的患者140例，男64例，女76例，年龄18～64岁，BMI 18～28 kg/m²，ASAⅠ或Ⅱ级。根据随机数字表法将患者分为四组：瑞马唑仑组（R组）、艾司唑仑组（E组）、瑞马唑仑联合艾司唑仑组（RE组）和对照组（C组），每组35例。R组麻醉诱导前静注瑞马唑仑；E组术前1晚口服艾司唑仑且麻醉诱导前静注生理盐水；RE组术前1晚口服艾司唑仑且麻醉诱导前静注瑞马唑仑；C组麻醉诱导前静注生理盐水。记录术前1 d访视时、入室后、静注瑞马唑仑或生理盐水后10 min的焦虑视觉模拟评分（VAS-A），术后首次肛门排气时间、首次排便时间，术后24 h恶心、呕吐的发生情况，术后第1晚睡眠质量评分。

结果与术前1 d访视时比较，入室后E组和RE组VAS-A评分明显降低，静注瑞马唑仑或生理盐水后10 min R组、E组和RE组VAS-A评分明显降低（P＜0.05）。与C组比较，E组和RE组入室后VAS-A评分明显降低，R组、E组和RE组静注瑞马唑仑或生理盐水后10 min VAS-A评分明显降低（P＜0.05），R组、E组和RE组术后首次肛门排气、排便时间明显缩短（P＜0.05），R组、E组和RE组术后第1晚睡眠质量评分明显升高（P＜0.05）。四组术后24 h恶心、呕吐的发生率差异无统计学意义。

结论 术前单独应用瑞马唑仑或艾司唑仑，以及二者联合应用均可以有效缓解腹腔镜胆囊切除术患者术前焦虑状态，加快术后胃肠功能恢复，改善患者术后第1晚睡眠质量。

英文摘要:

      
Objective To investigate the effects of remimazolam and estazolam reliefing preoperative anxiety on recovery of gastrointestinal function in patients undergoing laparoscopic surgery.

Methods A total of 140 patients undergoing elective laparoscopic cholecystectomy surgery, 64 males and 76 females, aged 18-64 years, BMI 18-28 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly assigned into 4 group: remimazolam group (group R), estazolam group (group E), remimazolam combined with estazolam group (group RE), and control group (group C), 35 patients in each group. Group R received intravenous injection of remimazolam before induction of anesthesia, group E received oral estazolam in the night before surgery and intravenous injection of normal saline before induction of anesthesia, group RE were not only given estazolam orally in the night before surgery but also injected remimazolam intravenously before induction of anesthesia, and group C were given normal saline before induction of anesthesia. The VAS-A scores were recorded during preoperative visit, after entering the room, 10 minutes after intravenous remimazolam or saline. Time of the first postoperative exhaust and defecation, occurrence of nausea and vomiting within 24 hours after surgery, sleep quality scores of the night after surgery were recorded.

Results Compared with preoperative visit, the VAS-A scores of groups E and RE were significantly decreased after entering the room, and the VAS-A scores of groups R, E and RE were significantly decreased 10 minutes after intravenous remimazolam or saline (P < 0.05). Compared with group C, the VAS-A scores of groups E and RE decreased significantly after entering the room, and the VAS-A scores of groups R, E and RE decreased significantly 10 minutes after intravenous remimazolam or saline (P < 0.05). Compared with group C, time of the first postoperative exhaust and defecation of groups R, E and RE were significantly reduced (P < 0.05). Compared with group C, sleep quality scores of groups R, E and RE were significantly higher at one night after surgery (P < 0.05). There was no significant difference in the incidence of nausea and vomiting among the four groups within 24 hours after surgery.

Conclusion Remimazolam and estazolam used alone or in combination before surgery can effectively relieve preoperative anxiety, thus accelerate the recovery of postoperative gastrointestinal function, and can also improve sleep quality in the night after surgery in patients undergoing laparoscopic cholecystectomy surgery.