Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, People's Republic of China.
Drug Des Devel Ther. 2024 Nov 13;18:5183-5192. doi: 10.2147/DDDT.S489167. eCollection 2024.
This study aimed to compare the impact of remimazolam-based versus propofol-based intravenous anesthesia on surgical stress and post-operative immune function in patients undergoing gastric radical surgery.
Sixty-eight patients aged 50 to 80 undergoing gastric radical surgery were randomly assigned to the remimazolam group (group R) or the propofol group (group P), receiving remimazolam or propofol-based intravenous anesthesia, respectively. The primary outcome measured was peri-operative serum stress indicators and lymphocyte subtypes. Secondary outcomes included hemodynamic vitals, recovery quality, postoperative pain profiles and potential adverse effects.
The demographic and surgical characteristics of the 60 analyzed patients were comparable. The absolute counts of CD3+CD4+ and CD3+CD8+ cell decreased significantly on POD1 compared with baseline. On POD3, the numbers of CD3+CD4+ cells in group R were lower than baseline and Group P, whereas the CD3+CD8+ cell counts in both groups were lower than baseline, with group R higher than group P. The CD3-CD16+CD56+ cell numbers in both groups on POD1 and POD3 decreased significantly compared to baseline with group P lower than group R on POD3. The serum levels of IL-1β, IL-6, TNF-α, ACTH and COR rose sharply 2 hours after the beginning of surgery compared to baseline. Notably, all these parameters in group R were higher than those in group P. Additionally, blood pressure and intra-operative vasoactive drug frequency in group R were higher than that in group P. No significant differences in recovery quality, postoperative pain profiles, and potential adverse effects were observed.
Remimazolam-based intravenous anesthesia might favour the recovery of cellular immune function in early postoperative period compared to propofol. On the contrary, remimazolam was inferior to propofol in suppressing surgical stress. Further studies with larger sample sizes are needed to confirm our findings.
本研究旨在比较瑞马唑仑与依托咪酯静脉麻醉对行胃癌根治术患者手术应激及术后免疫功能的影响。
选择 2020 年 1 月至 2022 年 1 月 68 例行胃癌根治术的患者，年龄 50~80 岁，采用随机数字表法分为瑞马唑仑组（R 组）和依托咪酯组（P 组），分别接受瑞马唑仑和依托咪酯静脉麻醉。主要结局为围术期血清应激指标和淋巴细胞亚群。次要结局包括血流动力学指标、苏醒质量、术后疼痛评分和不良反应。
60 例患者的一般资料和手术情况比较差异无统计学意义。与基础值相比，两组患者术后第 1 天（POD1）的 CD3+CD4+和 CD3+CD8+细胞绝对计数显著下降。术后第 3 天（POD3），R 组 CD3+CD4+细胞计数低于基础值和 P 组，而两组的 CD3+CD8+细胞计数均低于基础值，且 R 组高于 P 组。两组患者术后第 1 天和第 3 天的 CD3-CD16+CD56+细胞计数均明显低于基础值，且 P 组低于 R 组。术后第 3 天，R 组的白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、促肾上腺皮质激素（ACTH）和皮质醇（COR）血清水平与基础值相比急剧升高，且均高于 P 组。此外，R 组的血压和术中血管活性药物使用频率均高于 P 组。两组患者的苏醒质量、术后疼痛评分和不良反应发生率比较差异无统计学意义。
与依托咪酯相比，瑞马唑仑静脉麻醉可能更有利于术后早期细胞免疫功能的恢复。相反，瑞马唑仑在抑制手术应激方面逊于依托咪酯。需要更大样本量的研究来证实我们的发现。
