瑞马唑仑与咪达唑仑用于心脏同步电复律镇静效果的比较

Comparison of remazolam and midazolam for sedation of synchronous electrical cardioversion

中文关键词: 瑞马唑仑  咪达唑仑  心房颤动  电复律  镇静

英文关键词: Remazolam  Midazolam  Atrial fibrillation  Electrical cardioversion  Sedation

中文摘要:

      
目的：比较瑞马唑仑与咪达唑仑在心房颤动患者心脏同步电复律中的镇静效果与安全性。
方法：选择2021年1月至2022年12月行心脏同步电复律的心房颤动患者32例，男22例，女10例，年龄18～80岁，BMI 20～30 kg/m²，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者随机分为两组：瑞马唑仑组和咪达唑仑组，每组16例。瑞马唑仑组静注瑞马唑仑0.2 mg/kg进行镇静，咪达唑仑组静注咪达唑仑0.025 mg/kg进行镇静，两组推药时间均为1 min。记录麻醉起效时间、苏醒时间和定向力恢复时间。记录麻醉诱导前（T1）、睫毛反射消失时（T2）、电复律完成后（T3）、苏醒时（T4）的SBP、DBP和SpO₂。在患者清醒后5 min行神经行为认知状态检查（NCSE），包括语言能力、结构能力、记忆力、计算能力和推理能力，计算每项能力测试的通过率。记录术中（体动、呼吸暂停）及术后12 h内（恶心呕吐、胸痛）不良反应的发生情况。
结果：与咪达唑仑组比较，瑞马唑仑组麻醉起效时间、苏醒时间、定向力恢复时间明显缩短（P<0.05）。两组不同时点SBP、DBP和SpO₂差异无统计学意义。与咪达唑仑组比较，清醒后5 min瑞马唑仑组推理能力测试的通过率明显升高（P<0.05）。两组不良反应发生率差异无统计学意义。
结论：与咪达唑仑比较，瑞马唑仑用于心房颤动同步电复律术前镇静起效更快、苏醒更快、定向力恢复更快，术后患者NCSE中的推理能力恢复更快。

英文摘要:

      
Objective: To compare the sedative effect and safety of remimazolam and midazolam in synchronous electrical cardioversion in patients with atrial fibrillation.
Methods: Thirty-two patients with atrial fibrillation receiving synchronous electrical cardioversion from January 2021 to December 2022 were enrolled, 22 males and 10 females, aged 18-80 years, BMI 20-30 kg/m², ASA physical status Ⅱ or Ⅲ. The patients were randomly divided into two groups using random number table method: remimazolam group and midazolam group, 16 patients in each group. The remimazolam group was sedated with 0.2 mg/kg of intravenous remimazolam, and the midazolam group was sedated with 0.025 mg/kg of midazolam intravenously, and the drug injection time in both groups was 1 min. The anesthesia onset time, awakening time, and orientation recovery time were recorded. SBP, DBP, and SpO₂ were recorded before anesthesia induction (T1), when the eyelash reflex was absent (T2), after the completion of electrical cardioversion (T3), and at the time of awakening (T4). Neurobehavioral cognitive state examination (NCSE) was performed 5 minutes after the patients were awake, including language ability, structural ability, memory, calculation ability and reasoning ability, and the pass rate of each ability test was calculated. The occurrence of adverse reactions during surgery (body movement, apnea) and within 12 hours after surgery (nausea, vomiting, and chest pain) was recorded.
Results: Compared with the midazolam group, the anesthesia onset time, awakening time, and orientation recovery time in the remimazolam group were significantly shortened (P < 0.05). There was no significant difference in SBP, DBP, and SpO₂ between the two groups at different time points. Compared with the midazolam group, the pass rate of the reasoning ability test was higher in the remimazolam group 5 minutes after awakening (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups.
Conclusion: Compared with midazolam, remimazolam has faster onset of sedation, faster awakening, faster recovery of orientation in synchronous electrical cardioversion of atrial fibrillation, and faster recovery of reasoning ability in NCSE after synchronous electrical cardioversion.