Fan Jianjun, Zhang Zhiguo, Wang Jie, Han Dianwei, Zhen Yongbo, Fan Jinpei, Wang Shuai, Wang Fei
Department of Anesthesiology, The Third Hospital of Baogang Group, Baotou, China.
Department of Anesthesiology, The Third Hospital of Baogang Group, Baotou, China.
Clin Ther. 2025 Jan;47(1):3-8. doi: 10.1016/j.clinthera.2024.09.020. Epub 2024 Oct 28.
To evaluate the effectiveness of remimazolam in preventing adverse reactions triggered by carboprost tromethamine during cesarean section procedures.
A total of 200 parturients scheduled for cesarean sections at risk of postpartum hemorrhage in our hospital from October 2022 to July 2023 were included. The participants were assigned via random number table method to either a study group or a control group, resulting in 100 cases in each. All parturients received combined spinal and epidural anesthesia (CSEA) during cesarean section, followed by administration of carboprost tromethamine (250 µg) for preventing postpartum hemorrhage after childbirth. CSEA was performed with 1.8 to 2 mL of 0.5% bupivacaine and 7 to 10 mL of 2% lidocaine. The study group was given remimazolam via intravenous infusion at a rate of 0.3 mg/kg/h commencing at 1 minute prior to CSEA and concluding with a final dosage adjustment 20 minutes preceding the end of surgery, while the control group was given the same volume of saline within this time frame. Primary outcome measures were adverse reactions and sedative effects of the parturients.
Nausea and vomiting were the only adverse reactions that exhibited significant differences between groups. The study group reported significantly fewer cases (32 cases) of nausea and vomiting when compared to the 48 cases observed in the control group. Moreover, the use of remimazolam appeared to alleviate the severity of nausea and vomiting, as evidenced by the significantly lower incidence of Grade III event and the higher risk of Grade I event in comparison with the control group (P < 0.05). The Apgar scores of newborns at birth and 5 minutes after birth were compared, and no statistically significant difference was found (P > 0.05). Parturients receiving remimazolam exhibited better effective sedation outcomes and were more satisfied with the treatment when compared with controls (P < 0.05). There were no significant differences in postpartum bleeding volume at 2 and 12 hours postpartum, as well as in the duration of postpartum bleeding between the two groups (P > 0.05).
Intravenous administration of remimazolam effectively prevents adverse reactions induced by carboprost tromethamine during cesarean section performed under CSEA, thereby improving sedative effects.
评估瑞马唑仑在剖宫产手术中预防卡前列甲酯栓引发不良反应的有效性。
纳入2022年10月至2023年7月在我院计划行剖宫产且有产后出血风险的200例产妇。通过随机数字表法将参与者分为研究组和对照组，每组100例。所有产妇在剖宫产期间均接受腰硬联合麻醉（CSEA），随后给予卡前列甲酯栓（250μg）以预防产后出血。CSEA采用1.8至2mL的0.5%布比卡因和7至10mL的2%利多卡因进行。研究组在CSEA前1分钟开始以0.3mg/kg/h的速率静脉输注瑞马唑仑，并在手术结束前20分钟进行最终剂量调整，而对照组在此时间段内给予相同体积的生理盐水。主要观察指标为产妇的不良反应和镇静效果。
恶心和呕吐是两组间唯一表现出显著差异的不良反应。研究组报告的恶心和呕吐病例（32例）明显少于对照组的48例。此外，使用瑞马唑仑似乎减轻了恶心和呕吐的严重程度，与对照组相比，III级事件发生率显著降低，I级事件风险更高（P<0.05）。比较新生儿出生时和出生后5分钟的Apgar评分，未发现统计学显著差异（P>0.05）。与对照组相比，接受瑞马唑仑的产妇表现出更好的有效镇静效果，对治疗更满意（P<0.05）。两组产后2小时和12小时的出血量以及产后出血持续时间无显著差异（P>0.05）。
在CSEA下进行剖宫产时，静脉注射瑞马唑仑可有效预防卡前列甲酯栓引起的不良反应，从而改善镇静效果。
