甲苯磺酸瑞马唑仑和依托咪酯对心脏手术血流动力学的影响比较：一项随机对照试验

贵州医科大学   麻醉与心脏电生理课题组

翻译：马艳燕 

编辑：柏雪

审校：曹莹

背景：甲苯磺酸瑞马唑仑（RT）是一种新型超短效γ-氨基丁酸A亚型（GABAA）激动剂，具有起效快和代谢快，对心肺功能抑制作用小等特点。目前，很少有研究比较RT和依托咪酯对麻醉诱导期间血流动力学的影响。在这里，我们旨在比较不同剂量的RT和依托咪酯对接受心脏手术的患者麻醉诱导的血流动力学影响。

方法：在这项单中心、前瞻性、随机、双盲试验中，于2022年1月至9月招募患者。共117例行择期瓣膜置换手术的患者分别随机分为低剂量RT（0.2 mg/kg）组（LR组）、高剂量RT（0.3 mg/kg）组（HR组）或依托咪酯（1.5 mg/kg）组（E组）。主要结局是麻醉诱导期间的血流动力学波动（平均动脉压波动值[∆MAP];心率波动值[∆HR]）。次要结局包括药物不良反应（注射疼痛和肌痉挛）和不良心血管事件的发生率、不同时间点的生命体征和血管活性药物的累积剂量。

结果：LR组和E组血流动力学波动（∆MAP）显著低于HR组。此外，E组和LR组的低血压发生率和使用去甲肾上腺素的累积剂量也明显低于HR组。与E组相比，LR组和HR组注射疼痛和肌痉挛的发生率较低。两组在∆HR、心动过速、高血压、重度心动过缓、不同时间点生命体征、乳酸和血糖方面差异无统计学意义。

结论：与依托咪酯相比，低剂量RT（0.2mg/kg）不仅能提供稳定的血流动力学参数，而且用于心脏病患者麻醉诱导时引起的不良反应更少。

原始文献来源：Hu B, Zhang M, Wu Z, Zhang X, Zou X, Tan L, Song T, Li X. Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial. Drug Des Devel Ther. 2023 Feb 8;17:381-388.

英文原文：

 Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial

Background: Remimazolam tosilate (RT) is a new ultrashort-acting γ-aminobutyric acid subtype A (GABAA) agonist, with the characteristics of rapid onset and offset, minimal cardiorespiratory depression. Currently, few studies have compared the effect of RT and etomidate on hemodynamics during anesthesia induction. Here, we aimed to compare the hemodynamic effects of different doses of RT and etomidate for anesthesia induction in patients undergoing cardiac surgeries.

Methods: Patients were recruited from January to September 2022 in this single-center, prospective, randomized, double-blind trial. A total of 117 patients undergoing selective valve replacement surgery were randomly divided into low-dose RT (0.2 mg/kg) group (group LR), high-dose RT (0.3 mg/kg) group (group HR), or etomidate (1.5 mg/kg) group (group E), respectively. The primary outcome was hemodynamic fluctuations (mean arterial pressure fluctuation value [∆MAP]; heart rate fluctuation value [∆HR]) during anesthesia induction. Secondary outcomes included the incidence of adverse drug reactions (injection pain and myoclonus) and adverse cardiovascular events, vital signs at different time points and the cumulative doses of vasoactive drugs.

Results: The hemodynamic fluctuations (∆MAP) in group LR and group E were significantly lower than that in group HR. In addition, the incidence of hypotension and the cumulative norepinephrine doses in group E and group LR were also significantly lower than that in group HR. Furthermore, the incidence of injection pain and myoclonus in group LR and group HR were less frequently recorded compared with group E. There were no significant differences in terms of ∆HR, tachycardia, hypertension, severe bradycardia, vital signs at different time points, lactic acid and blood glucose between both groups.

Conclusion: Compared with etomidate, low-dose RT (0.2mg/kg) can not only provide stable hemodynamic parameters but also cause fewer adverse reactions when used for anesthesia induction in patients with cardiac disease.

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来源 | 健康界

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