瑞马唑仑或丙泊酚麻醉下关节镜下半月板切除术后的恢复质量：一项随机对照试验。
完整摘要 · 中文译文
背景：麻醉技术可能影响术后恢复质量（QoR）。瑞马唑仑可能提供血流动力学稳定性和良好的早期恢复特征，但其与丙泊酚相比对患者自报QoR的影响仍不清楚。这在小型骨科手术中尤为重要，因为QoR是主要结局指标。本随机对照试验使用QoR-40问卷比较了基于丙泊酚和基于瑞马唑仑的全静脉麻醉（TIVA）后的术后QoR。 材料与方法：80例接受择期关节镜下半月板切除术的成年患者被随机分配至基于丙泊酚或基于瑞马唑仑的TIVA组；71例患者完成了QoR-40问卷并纳入最终分析（丙泊酚组36例，瑞马唑仑组35例）。主要结局指标为术后第1天（POD 1）的总体QoR-40评分。次要结局指标包括术中血流动力学变量、麻醉和镇痛药需求、术后恢复情况、疼痛评分以及术后恶心和呕吐。 结果：POD 1的总体QoR-40评分在丙泊酚组和瑞马唑仑组之间无显著差异（166.1 ± 16.8 vs. 170.6 ± 13.6；平均差 -4.5，95% CI -11.8至2.7；P = 0.218）。在探索性分析中，瑞马唑仑组的情感状态域评分较高（37.0 ± 4.3 vs. 39.2 ± 2.5；平均差 -2.2，95% CI -3.9至-0.6；P = 0.009）。瑞马唑仑组达到完全清醒的时间更长（18 [15-24] vs. 37 [31-45] min；P < 0.001），且麻醉后……（后续内容缺失，但按原文逐句翻译，此处未提供更多文本） 重症监护病房停留时间（30 [30-39] 分钟 vs. 38 [30-50] 分钟；P = 0.008）。需要麻黄碱处理的术中低血压在丙泊酚组中更常见（44.4% vs. 17.1%；P = 0.013）。 结论：在接受择期关节镜半月板切除术的成人患者中，基于丙泊酚和基于瑞马唑仑的全凭静脉麻醉在术后第1天的总体QoR-40评分无显著差异，尽管瑞马唑仑与更好的术中血流动力学稳定性相关，但代价是恢复至完全清醒的时间较慢。
完整摘要 · 英文原文
BACKGROUND: Anesthetic technique may influence postoperative quality of recovery (QoR). Remimazolam may offer hemodynamic stability and favorable early recovery characteristics, but its effect on patient-reported QoR compared with propofol remains unclear. This is particularly relevant in minor orthopedic surgery, where QoR is a principal outcome. This randomized controlled trial compared postoperative QoR between propofol-based and remimazolam-based total intravenous anesthesia (TIVA) using the QoR-40 questionnaire. MATERIALS AND METHODS: Eighty adult patients undergoing elective arthroscopic meniscectomy were randomly assigned to propofol-based or remimazolam-based TIVA; 71 patients completed the QoR-40 questionnaire and were included in the final analysis (36 in the Propofol group, 35 in the Remimazolam group). The primary outcome was the global QoR-40 score on postoperative day (POD) 1. Secondary outcomes included intraoperative hemodynamic variables, anesthetic and analgesic requirements, postoperative recovery profiles, pain scores, and postoperative nausea and vomiting. RESULTS: Global QoR-40 scores on POD 1 did not differ significantly between the Propofol and Remimazolam groups (166.1 ± 16.8 vs. 170.6 ± 13.6; mean difference -4.5, 95% CI -11.8 to 2.7; P = 0.218). In an exploratory analysis, the emotional-state domain scores were higher in the Remimazolam group (37.0 ± 4.3 vs. 39.2 ± 2.5; mean difference -2.2, 95% CI -3.9 to -0.6; P = 0.009). The Remimazolam group had a longer time to full alertness (18 [15-24] vs. 37 [31-45] min; P < 0.001) and longer post-anesthesia care unit stay (30 [30-39] vs. 38 [30-50] min; P = 0.008). Intraoperative hypotension requiring ephedrine occurred more frequently in the Propofol group (44.4% vs. 17.1%; P = 0.013). CONCLUSIONS: Global QoR-40 scores on POD 1 did not differ significantly between propofol-based and remimazolam-based TIVA in adults undergoing elective arthroscopic meniscectomy, although remimazolam was associated with greater intraoperative hemodynamic stability at the cost of slower return to full alertness.