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瑞马唑仑对接受腹腔镜手术的儿童苏醒期谵妄的影响：一项双盲随机试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：黄祥 编辑：杨荣峰 审校：曹莹
预防苏醒期谵妄是儿科麻醉的一个临床目标，但目前尚无统一的预防方法。本研究旨在探讨连续输注或单次推注瑞马唑仑是否能降低儿童苏醒期谵妄的发生率。
共有120名1-6岁的儿童被随机平均分配到三个组中：RC组，接受1 mg·kg−1·h−1的瑞马唑仑持续输注；RB组，在伤口缝合开始时接受0.2 mg·kg−1的瑞马唑仑单次推注；C组，接受1 ml·kg−1·h−1的生理盐水持续输注，并在缝合开始时接受0.2 ml·kg−1的生理盐水单次推注。主要结局指标是根据儿科麻醉苏醒期谵妄量表评估的苏醒期谵妄发生率。次要结局包括麻醉后监护室中使用丙泊酚抢救的次数、恢复时间和不良事件。
在C组中，40例患者中有14例（35%）出现苏醒期谵妄，而在RC组中，40例患者中有2例（5%）出现苏醒期谵妄（与C组相比，P = 0.001；风险比，95% CI：0.14，0.04-0.59），在RB组中，39例患者中有3例（7.7%）出现苏醒期谵妄（与C组相比，P = 0.003；风险比，95% CI：0.22，0.07-0.71）。C组中有10例患者，RC组中有2例患者（与C组相比，P = 0.012；风险比，95% CI：0.20，0.05-0.86），RB组中有2例患者（与C组相比，P = 0.014；风险比，95% CI：0.21，0.05-0.88）需要使用丙泊酚抢救。未检测到恢复时间和不良反应方面的差异。
瑞马唑仑的连续输注和单次推注给药均能有效降低儿童苏醒期谵妄的发生率。
原始文献来源：Yu-Hang Cai, John Wei Zhong, Hong-Yu Ma, Peter Szmuk, Cheng-Yu Wang, Zhen Wang, Xu-Lin Zhang, Le-Qi Dong, Hua-Cheng Liu; Effect of Remimazolam on Emergence Delirium in Children Undergoing Laparoscopic Surgery: A Double-blinded Randomized Trial. Anesthesiology 2024; 141:500–510 doi: https://doi.org/10.1097/ALN.0000000000005077
Effect of Remimazolam on Emergence Delirium in Children Undergoing Laparoscopic Surgery: A Double-blinded Randomized Trial
Background
Preventing emergence delirium is a clinical goal for pediatric anesthesia, yet there is no consensus on its prevention. This study investigated the hypothesis that a continuous infusion or a single bolus of remimazolam can reduce the incidence of emergence delirium in children.
Methods
A total of 120 children aged 1 to 6 yr were randomly and equally allocated into three groups: group RC, which received a continuous infusion of remimazolam at 1 mg · kg−1· h−1; group RB, which received a single bolus of remimazolam at 0.2 mg · kg−1at the beginning of wound closure; and group C, which received a continuous infusion of saline at 1 ml · kg−1· h−1and a single bolus of saline at 0.2 ml · kg−1at the beginning of sutures. The primary outcome was the incidence of emergence delirium assessed by the Pediatric Anesthesia Emergence Delirium scale. Secondary outcomes included the number of rescue propofol administrations in the postanesthesia care unit, recovery time, and adverse events.
Results
Emergence delirium was observed in 14 of 40 (35%) patients in group C, 2 of 40 (5%) patients in group RC (vs. group C, P = 0.001; risk ratio, 95% CI: 0.14, 0.04 to 0.59), and 3 of 39 (7.7%) patients in group RB (vs. group C, P = 0.003; risk ratio, 95% CI: 0.22, 0.07 to 0.71). Ten of 40 patients in group C, 2 of 40 patients in group RC (vs. group C, P = 0.012; risk ratio, 95% CI: 0.20, 0.05 to 0.86), and 2 of 39 patients in group RB (vs. group C, P = 0.014; risk ratio, 95% CI: 0.21, 0.05 to 0.88) needed rescue propofol. No differences in the recovery time and adverse effects were detected.
Conclusions
Both continuous infusion and single bolus administration of remimazolam can effectively reduce the occurrence of emergence delirium in children.
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