口腔医学研究

口腔医学研究 ›› 2023, Vol. 39 ›› Issue (11): 973-977.DOI: 10.13701/j.cnki.kqyxyj.2023.11.007

• 口腔颌面外科学研究 • 上一篇    下一篇

甲苯磺酸瑞马唑仑与丙泊酚用于深度镇静下三叉神经痛射频热凝术的比较研究

李进杰, 张铁军*   

  1. 武汉大学口腔医院麻醉科,口颌系统重建与再生全国重点实验室,口腔生物医学教育部重点实验室,口腔医学湖北省重点实验室,武汉大学口腔医(学)院 湖北 武汉 430079
  • 收稿日期:2023-08-29 出版日期:2023-11-28 发布日期:2023-11-22
  • 通讯作者: *张铁军,E-mail:ztj@whu.edu.cn
  • 作者简介:李进杰(1982~ ),男,武汉人,硕士,主治医师,研究方向:麻醉机理。
  • 基金资助:
    科技发展基金会临床研究基金(编号:CXPJJH12000005-07-48)

Comparative Study on Remimazolam Mesylate and Propofol for Radiofrequency Thermocoagulation of Trigeminal Neuralgia under Deep Sedation

LI Jinjie, ZHANG Tiejun*   

  1. Department of Anesthesiology, Hospital of Stomatology, Wuhan University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2023-08-29 Online:2023-11-28 Published:2023-11-22

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摘要： 目的: 比较甲苯磺酸瑞马唑仑与丙泊酚在深度镇静下射频热凝术治疗三叉神经痛中的应用。方法: 选择择期在深度镇静下行三叉神经射频热凝术的患者78例,随机分为R组和B组(n=39),分别采用甲苯磺酸瑞马唑仑和丙泊酚复合瑞芬太尼进行麻醉。比较两组患者麻醉诱导前5 min(T1)、改良警觉/镇静评分(MOAA/S)≤3分时(T2)、射频热凝开始(T3)、射频热凝结束时(T4)、清醒时(T5)的平均动脉压(MAP)、心率和血氧饱和度(SpO2);比较两组不良反应(呼吸抑制例数、给药至MOAA/S≤3期间体动、术中体动例数、循环抑制、注射痛)的发生情况;比较两组辅助呼吸方式(面罩吸氧、托下颌面罩吸氧及托下颌面罩加压给氧)的情况。结果: 与T1时比较,B组T2时MAP和SpO2均下降(P<0.05),T3和T4时SpO2下降(P<0.05),而R组T3时SpO2下降(P<0.05)。与B组比较,R组呼吸抑制、注射痛及采用托下颌面罩加压给氧的发生率均降低(P<0.05),而T2和T4时SpO2升高,给药至MOAA/S≤3期间体动和采用面罩吸氧的发生率增加(P<0.05)。两组患者其他指标比较差异无统计学意义(P>0.05)。结论: 与丙泊酚相比较,甲苯磺酸瑞马唑仑对呼吸系统、循环系统的影响轻微,无注射痛,辅助呼吸方式简单,可以更安全、有效地用于深度镇静下三叉神经痛射频热凝术。

关键词: 瑞马唑仑, 丙泊酚, 三叉神经痛, 射频热凝术

Abstract: Objective: To compare the efficacy and safety of remimazolam mesylate and propofol for radiofrequency thermocoagulation of trigeminal neuralgia under deep sedation. Methods: A total of 78 patients who underwent elective radiofrequency thermocoagulation of the trigeminal nerve under deep sedation were enrolled and randomly divided into group R and B (n=39). Patients in group B were anesthetized with propofol combined with remifentanil, while those in group R were anesthetized with remimazolam combined with remifentanil. The mean arterial pressures, heart rates, and pulse oxygen saturations of both groups were compared at five time points: 5 minutes before anesthesia (T1), the time of modified alertness/sedation score (MOAA/S) ≤3 (T2), the time of beginning of radiofrequency thermocoagulation (T3), the time of the end of radiofrequency thermocoagulation (T4), and the time of awakening (T5). Furthermore, both groups were compared for the adverse reaction (respiratory inhibition, circulatory inhibition, body movements during administration to MOAA/S≤3 and operation, and injection pain), and for the modes of assisted breathing (mask oxygenation, oxygenation by mandibular lift and face mask, and oxygenation by mandibular lift and face mask under pressure). Results: Compared with those at T1, both MAP and SpO2 decreased at T2 and SpO2 decreased at T3 and T4 in group B (P<0.05), while only SpO2 reduced at T3 in group R (P<0.05). Compared with group B, the incidence of breathing inhibition, injection pain and oxygen administration with mandibular lift and face mask under pressure were reduced in group R (P<0.05), while SpO2 was increased at T2 and T4, and the incidence of body movement during administration to MOAA/S≤3 and the incidence of oxygen administration using a mask were increased (P<0.05). Other indicators were not significantly different between two groups (P>0.05). Conclusion: Compared with propofol, remimazolam mesylate has a low incidence of respiratory and circulatory inhibition, no injection pain, and a simple mode of assisted breathing, which can be used more safely and effectively for radiofrequency thermocoagulation of trigeminal neuralgia under deep sedation.

Key words: remimazolam, propofol, trigeminal neuralgia, radiofrequency thermocoagulation