【原】【罂粟摘要】比较瑞马唑仑与丙泊酚用于全静脉麻醉后患者的术后主观恢复质量：一项荟萃分析

比较瑞马唑仑与丙泊酚用于全静脉麻醉后患者的术后主观恢复质量：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：柏雪  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，最近作为丙泊酚的替代品被引入全身麻醉。虽然这两种药物在安全性和有效性方面已进行了比较，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丙泊酚对全身麻醉手术患者主观QoR的影响。

方法：检索Medline、Embase、Google Scholar和Cochrane中央对照试验注册库(Central Register of Controlled Trials)，搜索从成立到2024年5月28日的随机对照试验，比较瑞马唑仑和丙泊酚在术后QoR方面的差异。采用Cochrane偏倚风险工具(RoB 2)评估研究质量。采用随机效应荟萃分析评估术后第1天(POD) QoR评分(主要结局)、第2-3天QoR评分、QoR维度、失去意识时间、其他恢复特征和补救性镇痛需求。

结果：这项荟萃分析纳入了2022年至2024年间发表的13项研究，涉及1418名患者。QoR评估使用QoR 15问卷（10项研究）或QoR 40问卷（3项研究）。结果显示，瑞马唑仑与丙泊酚在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、麻醉后恢复室(PACU)停留时间、拔管时间以及躁动和术后恶心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)，但比给予丙泊酚的患者意识恢复更快(MD:−1.60 min)。此外，使用瑞马唑仑后在PACU的镇痛需求较低（风险比：0.62，95% CI：0.43, 0.89，P = 0.009，I² = 0%），但在病房中无此差异。

结论：瑞马唑仑与丙泊酚QoR相似，在意识恢复和术后镇痛方面具有优势，是全身麻醉中丙泊酚的理想替代药。

原始文献来源：Kuo‑Chuan Hung, Wei‑Ting Wang, Wei‑Cheng Liu, et al. Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis. Systematic Reviews (2024) 13:235  

Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis

Background Remimazolam is a novel ultrashortacting 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 efficacy, their relative effects on postoperative quality of recovery (QoR) remain unclear. Therefore, this meta analysis aimed to compare the effects 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 riskofbias 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 con sciousness, other recovery characteristics, and rescue analgesia requirement were evaluated using randomeffects metaanalyses.

Results This metaanalysis included 13 studies published between 2022 and 2024 involving 1,418 patients. QoR was evaluated using either the QoR15 (10 studies) or QoR40 (3 studies) questionnaire. The pooled results indicated no significant difference in the QoR scores on POD 1 (standardized mean difference: 0.02, 95% confidence interval [CI]: − 0.20, 0.23, P = 0.88, I² = 73%) and PODs 2–3 between remimazolam and propofol. Furthermore, no significant differences 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 difference (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, I² = 0%) but not in the ward.

Conclusion Remimazolam is a potential alternative to propofol for general anesthesia as it offers similar QoR to the latter and has advantages in terms of consciousness recovery and immediate postoperative analgesia requirement.

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