关注罂粟花，共同学习麻醉学最新文献！
比较瑞马唑仑和异丙酚为基础的外科手术全静脉麻醉的主观恢复质量：一项荟萃分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：王波 编辑：王婷婷 审校：曹莹
背景：瑞马唑仑是一种新型超短效苯二氮卓类药物，最近作为异丙酚的替代品被引入全身麻醉。虽然两种药物在安全性和有效性方面进行了比较，但它们对术后恢复质量（QoR）的相对影响尚不清楚。因此，本荟萃分析旨在比较瑞马唑仑和异丙酚对全身麻醉手术患者主观QoR的影响。
方法：检索了Medline、Embase、Google Scholar和科克伦对照试验中心注册中心从开始到2024年5月28日的数据，以识别比较瑞马唑仑和异丙酚术后QoR的随机对照试验。采用Cochrane偏倚风险工具（RoB 2）评估研究质量。采用随机效应meta分析评估术后第1天（POD） QoR评分（主要结局）、第2-3天QoR评分、QoR维度、至意识丧失时间、其他恢复特征和抢救镇痛需求。
结果：该荟萃分析纳入了2022年至2024年间发表的13项研究，涉及1418名患者。QoR采用QoR - 15（10项研究）或QoR - 40（3项研究）问卷进行评估。汇总结果显示，瑞马唑仑和异丙酚在POD 1和POD 2-3的QoR评分（标准化平均差为0.02,95%可信区间[CI]: - 0.20, 0.23, P = 0.88, I2 = 73%）无显著差异。此外，在QoR维度、麻醉后护理单位（PACU）停留时间、拔管时间以及躁动和术后恶心和呕吐的风险方面没有观察到显著差异。给予瑞马唑仑的患者麻醉诱导较慢（平均差值（MD）：32.27 s），但比给予异丙酚的患者意识恢复更快（MD:−1.60 min）。此外，瑞马唑仑在PACU中与较低的救援性镇痛需求风险相关（风险比：0.62,95% CI: 0.43, 0.89, P = 0.009, I2 = 0%），但在病房中与此无关。
Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis
Background Remimazolam is a novel ultra-short-acting benzodiazepine that has been recently introduced as an alternative to propofol for general anesthesia. While both agents have been compared in terms of safety and efcacy, their relative efects on postoperative quality of recovery (QoR) remain unclear. Therefore, this metaanalysis aimed to compare the efects of remimazolam and propofol on subjective QoR in surgical patients who underwent general anesthesia.
Methods Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception to May 28, 2024 to identify randomized controlled trials comparing remimazolam and propofol in terms of postoperative QoR. The Cochrane risk-of-bias tool (RoB 2) was used to assess study quality. QoR score on postoperative day (POD) 1 (primary outcome), QoR scores on PODs 2–3, QoR dimensions, time to loss of consciousness, other recovery characteristics, and rescue analgesia requirement were evaluated using random-efects meta-analyses.
Results This meta-analysis included 13 studies published between 2022 and 2024 involving 1,418 patients. QoR was evaluated using either the QoR-15 (10 studies) or QoR-40 (3 studies) questionnaire. The pooled results indicated no signifcant diference in the QoR scores on POD 1 (standardized mean diference: 0.02, 95% confdence interval [CI]:−0.20, 0.23, P=0.88, I 2=73%) and PODs 2–3 between remimazolam and propofol. Furthermore, no signifcant diferences were observed in QoR dimensions, length of postanesthesia care unit (PACU) stay, and time to extubation as well as in the risks of agitation and postoperative nausea and vomiting. Patients administered remimazolam exhibited slower anesthetic induction (mean diference (MD): 32.27 s) but faster recovery of consciousness (MD:−1.60 min) than those administered propofol. Moreover, remimazolam was associated with a lower risk of rescue analgesia requirement in the PACU (risk ratio: 0.62, 95% CI: 0.43, 0.89, P=0.009, I 2=0%) but not in the ward.
