| 汤艳辉
，李思琪
，黄丽丹
，宋文沁
，付湘云.右美托咪定与甲苯磺酸瑞马唑仑对麻醉恢复室成人苏醒期躁动的影响[J].神经损伤功能重建,2024,(8):452-456 |
| 右美托咪定与甲苯磺酸瑞马唑仑对麻醉恢复室成人苏醒期躁动的影响 |
| Effects of Dexmedetomidine and Remimazolam Tosilate on Emergence Agitation in Adults Pa⁃tients in the Post-anaesthetic Care Unit |
| |
| DOI： |
| 中文关键词: 急性躁动 右美托咪定 甲苯磺酸瑞马唑仑 |
| 英文关键词: emergence agitation dexmedetomidine remimazolam tosilate |
| 基金项目:湖北省卫生健康委
科研资助项目（右
美托咪定在调节高
龄患者睡眠稳态促
进神经认知功能的
作用及机制研究，
No. WJ2023F024） |
|
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| 中文摘要: |
| 目的：研究右美托咪定与甲苯磺酸瑞马唑仑对麻醉恢复室苏醒期躁动的影响。方法：本研究为单中
心、双盲、随机对照临床研究。纳入麻醉恢复室发生急性躁动且符合纳入和排除标准的患者186例，随机分
入甲苯磺酸瑞马唑仑组（R组）和右美托咪定组（D组）。分别静脉给予甲苯磺酸瑞马唑仑（0.1 mg/kg）或右
美托咪定（0.4 µg/kg），若患者未入睡，再重复给予上述剂量至患者入睡；之后持续泵注甲苯磺酸瑞马唑仑
（20 mg/h）或右美托咪定（80 µg/h）30 min。收集治疗期间生命体征、手术时间、手术类型、数字疼痛强度量
表（numeric rating scale，NRS）评分、里士满焦虑量表（Richmond Agitation Sedation Scale，RASS）分级、4AT
评分、用药次数、起效时间和苏醒时间，术后第1天～第3天对患者进行4AT测试、评估不良事件，记录住院
时间数据。结果：最终158例完成研究，R组和D组各79例。2组一般资料差异无统计学意义（P＞0.05）。R
组用药次数低于 D 组（P＜0.05），入睡快于 D 组（P＜0.05），苏醒时间与 D 组的差异无统计学意义（P＞
0.05）。患者入睡（T2）及持续泵注 10 min（T3）时，D 组 MBP 高于 R 组，HR 低于 R 组（P＜0.05），持续泵注
20 min（T4）时，D组HR低于R组（P＜0.05）。D组与R组谵妄复发率无统计学意义（P＞0.05）。在治疗期间
D 组窦性心动过缓的发生率高于 R 组，高血压的发生率也高于 R 组，低血压的发生率低于 R 组（均 P＜
0.05）。2组的呼吸抑制、窦性心动过速、头晕、恶心、呕吐、导管相关膀胱刺激症、寒颤及谵妄差异无统计学
意义（P＞0.05）。EA发生后药物治疗前，2组患者谵妄的发生率在差异无统计学意义（P＞0.05）；但经甲苯
磺酸瑞马唑仑或右美托咪定治疗后，谵妄发生概率明显降低（P＜0.05）。结论：甲苯磺酸瑞马唑仑和右美托
咪定均对麻醉恢复室发生的EA有较好的疗效，甲苯磺酸瑞马唑仑起效更快、对循环的抑制更轻。 |
| 英文摘要: |
| To study the effects of dexmedetomidine and remimazolam tosilate on emergence agitation (EA) in adults patients in the post-anaesthetic care unit. Methods: This study is a single-center, double-blind, randomized controlled clinical trial. A total of 186 patients with EA occurring in the post-anaesthetic
care unit, who met the inclusion and exclusion criteria, were enrolled and randomly assigned to the remimazolam group (R group) or dexmedetomidine group (D group). Remimazel tosilate (0.1 mg/kg) or dexmedetomidine
(0.4 μg/kg) was given intravenously, respectively. If the patient did not fall asleep, the above dosage was repeated until the patient fell asleep; then continuous infusion of remimazolam tosilate (20 mg/h) or dexmedetomidine
(80 μg/h) was continued for 30 minutes. During treatment, vital signs, operative time, type of surgery, numerical
rating scale (NRS) score, Richmond Agitation Sedation Scale (RASS) level, 4AT score, number of medications
used, onset time and awakening time were collected. On postoperative day one to three, patients underwent 4AT
testing and assessment of adverse events, and hospital stay data were recorded. Results: A total of 158 cases
completed the study, with 79 cases in each R group and D group. There were no significant differences between
the two groups in general information (P>0.05). The number of medications used by the R group was lower than
that of the D group (P<0.05), and they fell asleep faster than the D group (P<0.05), but there was no significant
difference in awakening time between the two groups (P>0.05). At T2 (time of sleep onset) and T3 (10 min after
continuous infusion began), the mean blood pressure (MBP) in the D group was higher than that in the R group,
and heart rate (HR) was lower than that in the R group (P<0.05); at T4 (20 min after continuous infusion began),
the HR in the D group was lower than that in the R group (P<0.05). There was no significant difference in the incidence of delirium relapse between the two groups (P>0.05). During treatment, the incidence of sinus bradycardia and hypertension in the D group was higher than that in the R group, while the incidence of hypotension was
lower than that in the R group (all P<0.05). There were no significant differences between the two groups in re-
spiratory depression, sinus tachycardia, dizziness, nausea, vomiting, catheter-related bladder stimulation syndrome, chills, and delirium
(all P>0.05). Before pharmacotherapy after EA occurrence, there was no significant difference in delirium incidence between the two
groups (P>0.05); however, after treatment with remimazolam or dexmedetomidine, the probability of delirium occurrence significantly decreased (P<0.05). Conclusion: Both remimazolam tosilate and dexmedetomidine have good therapeutic effects on EA occurring in the
post-anaesthetic care unit, with remimazolam tosilate having a faster onset and less suppression of circulation. |
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