背景:瑞馬唑侖是一種苯二氮卓類新型超短效靜脈注射用的鎮(zhèn)靜催眠藥，可顯著縮短鎮(zhèn)靜起效和蘇醒時(shí)間，并可被氟馬西尼拮抗。丙泊酚是硬質(zhì)支氣管鏡檢查中應(yīng)用最廣的麻醉藥，但無特異性拮抗劑，其消除主要由心排量和肝臟代謝。本試驗(yàn)觀察在硬質(zhì)支氣管鏡下接受氣管內(nèi)手術(shù)的患者，應(yīng)用瑞馬唑侖與丙泊酚麻醉后，其蘇醒時(shí)間的比較。

方法：擇期行氣管內(nèi)腫瘤切除術(shù)或支架置入術(shù)的患者，采用隨機(jī)數(shù)字表法分為瑞馬唑侖組(R組)和丙泊酚組(P組)。R組：給予0.4 mg/kg瑞馬唑侖靜脈注射。P組：接受1.5 mg/kg丙泊酚靜脈注射。隨后兩組均使用0.2 mg/kg的羥考酮和0.9 mg/kg的羅庫溴銨進(jìn)行麻醉誘導(dǎo)。誘導(dǎo)后，兩組患者均采用高頻呼吸機(jī)經(jīng)硬質(zhì)支氣管鏡行正壓通氣，R組給予1 mg/kg/h的瑞馬唑侖和6-8μg/kg/h的瑞芬太尼維持。P組患者給予4-8 mg/kg/h的丙泊酚，瑞芬太尼6-8μg/kg/h麻醉維持，維持BIS在40-60，以維持足夠的麻醉深度。手術(shù)結(jié)束時(shí)，停止使用鎮(zhèn)靜藥和瑞芬太尼，取出硬質(zhì)支氣管鏡后直接將喉罩置入氣道。兩組均給予2-3 mg/kg Sugammadex 拮抗羅庫溴銨。TOF為90%時(shí)，R組使用氟馬西尼0.5 mg拮抗。符合拔管標(biāo)準(zhǔn)后取出LMA。主要觀察指標(biāo)為麻醉后的蘇醒時(shí)間。次要觀察指標(biāo)為鎮(zhèn)靜持續(xù)時(shí)間(LoC)、術(shù)中血流動(dòng)力學(xué)波動(dòng)和不良事件情況。

結(jié)果：共篩選出34例患者，30例患者納入研究。R組恢復(fù)時(shí)間(140±52s)明顯短于P組(374±195s) （P<0.001）。LoC時(shí)間R組為(76±40s), P組為(75±25s)，差異無統(tǒng)計(jì)學(xué)意義(P > 0.05)。兩組患者在血流動(dòng)力學(xué)波動(dòng)及不良事件方面差異均無統(tǒng)計(jì)學(xué)意義。

結(jié)論：瑞馬唑侖用于硬質(zhì)支氣管鏡檢查患者麻醉后蘇醒時(shí)間短于丙泊酚，兩種藥物之間無明顯血流動(dòng)力學(xué)波動(dòng)和不良事件發(fā)生的差異。與丙泊酚相比，瑞馬唑侖麻醉后可更快的蘇醒。

原始文獻(xiàn)來源：Yafei Pan , Mo Chen, Fulei Gu , Jinyan Chen , Wen Zhang , Zhangxiang Huang , Dapeng Zhu , Jia Song ,Jun Fang, Weifeng Yu , and Kangjie Xie.Comparison of Remimazolam-Flumazenil versus Propofol for Rigid Bronchoscopy: A Prospective RandomizedControlled Trial.J. Clin. Med. 2023, 12, 257. https:///10.3390/jcm12010257.

英文原文：

Comparison of Remimazolam-Flumazenil versus Propofol for

Rigid Bronchoscopy: A Prospective Randomized

Controlled Trial

Abstract

Background: Remimazolam is a novel ultrashort-acting intravenous benzodiazepine sedative–hypnotic that significantly reduces the times to sedation onset and recovery. This trial was conducted to confirm the recovery time from anesthesia of remimazolam-flumazenil versus propofol in patients undergoing endotracheal surgery under rigid bronchoscopy.

Methods: Patients undergoing endotracheal tumor resection or stent implantation were randomly allocated into a remimazolam group (Group R) or a propofol group (Group P). The primary outcome was the recovery time from general anesthesia. The secondary outcomes were the time to loss of consciousness (LoC),hemodynamic fluctuations, and adverse events.

Results: A total of 34 patients were screened,and 30 patients were enrolled in the study. The recovery time was significantly shorter for Group R (140 ± 52 s) than for Group P (374 ± 195 s) (p < 0.001). The times to LoC were 76 ± 40 s in Group R and 75 ± 25 s in Group P and were not significantly different. There were also no significant differences in hemodynamic fluctuations or adverse events between the two groups.

Conclusions: The recovery time from general anesthesia in rigid bronchoscopy patients was shorter using remimazolam-flumazenil than with propofol, with no dramatic hemodynamic fluctuations and adverse events or differences between the agents. Remimazolam-flumazenil allows for faster recovery from anesthesia than propofol.