中国临床药理学杂志

瑞马唑仑联合艾司氯胺酮全麻诱导对老年严重膝骨关节炎患者全膝关节置换术后的临床研究

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魏纯利 ¹^,² , 姚福旺 ² , 冯雨林 ¹^,² , 孙银贵 ¹^,²

中国临床药理学杂志 | 临床与基础桥接研究 2026,42(9): 1251-1257

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中国临床药理学杂志 |临床与基础桥接研究 2026 , 42 (9) : 1251 -1257

瑞马唑仑联合艾司氯胺酮全麻诱导对老年严重膝骨关节炎患者全膝关节置换术后的临床研究

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魏纯利¹^,², 姚福旺², 冯雨林¹^,², 孙银贵¹^,²

作者信息

^1.山东第二医科大学麻醉学院，山东潍坊 261053

^2.山东第二医科大学附属医院麻醉科，山东潍坊 261031

通讯作者:

孙银贵，主任医师，硕士生导师 MP: 13563666575 E-mail: m13061283582@163.com

作者简介:

魏纯利（1985-），男，副主任医师，主要从事临床麻醉与疼痛方面的工作和研究

Clinical trial of general anesthesia induction with remimazolam combined with esketamine in elderly patients with severe knee osteoarthritis after total knee arthroplasty

Chun-li WEI¹^,², Fu-wang YAO², Yu-lin FENG¹^,², Yin-gui SUN¹^,²

Affiliations

^1.College of Anesthesia, Shandong Second Medical University, Weifang 261053, Shandong Province, China

^2.Department of Anesthesiology, Affiliated Hospital of Shandong Second Medical University, Weifang 261031, Shandong Province, China

出版时间: 2026-05-17 doi: 10.13699/j.cnki.1001-6821.2026.09.009

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摘要

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目的

探讨注射用苯磺酸瑞马唑仑联合盐酸艾司氯胺酮注射液全麻诱导对老年严重膝骨关节炎患者全膝关节置换术的临床疗效及安全性。

方法

将收治的严重膝骨关节炎并进行全膝关节置换术的老年患者根据麻醉诱导方法分为对照组和试验组。试验组静注0.1 mg·kg^-1注射用苯磺酸瑞马唑仑联合0.5 mg·kg^-1盐酸艾司氯胺酮注射液进行麻醉诱导。对照组采用0.05 mg·kg^-1咪达唑仑注射液联合1 mg·kg^-1丙泊酚乳状注射液进行麻醉诱导。其余麻醉方法一致。比较2组复苏时间、血流动力学、术后疼痛评分（VAS）、术后镇静评分（Ramsay评分）、焦虑抑郁情绪评分（HAD）、简易精神状态检查表评分（MMSE）和谵妄（POD）发生情况，并进行安全性评价。

结果

共入组232例，试验组117例，对照组115例。对照组和试验组的复苏时间分别为（26.30±4.84）和（24.52±4.66）min，诱导后心率分别为（71.84±4.17）和（73.58±4.36）·min^-1，手术结束时心率分别为（74.59±4.46）和（76.13±4.32）beats·min^-1；诱导后平均动脉压分别为（81.90±5.69）和（84.11±5.72）mmHg，手术结束时平均动脉压分别为（86.73±5.57）和（88.51±6.43）mmHg；术后6 h VAS评分分别为（3.77±0.69）和（3.53±0.58）分，术后12 h VAS评分分别为（3.21±0.64）和（3.00±0.66）分；术后1 h Ramsay镇静评分分别为（3.82±0.66）和（3.21±0.57）分，术后6 h Ramsay评分分别为（2.65±0.48）分和（2.31±0.46）分；术后3 d HAD-A评分分别为（10.53±1.86）和（9.94±1.73）分，HAD-D评分分别为（10.56±2.10）和（9.86±2.05）分，MMSE评分分别为（21.34±1.82）和（22.22±1.93）分；术后7 d POD发生率分别为15.65%（18例/115例）和6.84%（8例/117例）；药物不良反应发生率分别为20.87%（24例/115例）和9.40%（11例/117例）；上述指标在组间比较，在统计学上差异均有统计学意义（P<0.05，P<0.01）。试验组和对照组在麻醉诱导期的主要药物不良反应包括低血压、高血压、心动过缓和心动过速。

结论

与咪达唑仑注射液联合丙泊酚乳状注射液方案相比，注射用苯磺酸瑞马唑仑联合盐酸艾司氯胺酮注射液麻醉诱导方案可以缩短复苏时间，维持血流动力学平稳，提高镇痛效果，降低抑郁情绪，提高认知功能，且安全性良好。

关键词

注射用苯磺酸瑞马唑仑 / 盐酸艾司氯胺酮注射液 / 全膝关节置换术 / 麻醉诱导 / 临床疗效 / 安全性

Abstract

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Objective

To investigate the clinical efficacy and safety of general anesthesia induced by benzenesulfonate remimazolam for injection combined with esketamine hydrochloride injection in elderly patients with severe knee osteoarthritis undergoing total knee arthroplasty.

Methods

The elderly patients with severe knee osteoarthritis undergoing total knee arthroplasty were divided into control group and treatment group according to the method of anesthesia induction. The treatment group received intravenous injection of 0.1 mg·kg^-1 benzenesulfonate remimazolam for injection combined with 0.5 mg·kg^-1 esketamine hydrochloride injection for anesthesia induction. The control group received 0.05 mg·kg^-1 midazolam injection combined with 1 mg·kg^-1 propofol emulsion injection for anesthesia induction. The other anesthesia methods were consistent between the two groups. The recovery time, hemodynamics, postoperative pain score (VAS), postoperative sedation score (Ramsay sedation scale), anxiety and depression score (HAD), mini-mental state examination score (MMSE), incidence of delirium (POD) and adverse anesthetic events were compared between the two groups.

Results

A total of 232 patients were enrolled, with 115 cases in control group and 117 cases in treatment group. The recovery time of the control group and the treatment group were (26.30±4.84) and (24.52±4.66) min, respectively; heart rate after induction were (71.84±4.17) and (73.58±4.36) beats·min^-1, respectively; heart rate at the end of operation were (74.59±4.46) and (76.13±4.32) beats·min^-1, respectively; mean arterial pressure after induction were (81.90±5.69) and (84.11±5.72) mmHg, respectively; mean arterial pressure at the end of operation were (86.73±5.57) and (88.51±6.42) mmHg, respectively; VAS scores at 6 h after operation were (3.77±0.54) and (3.53±0.69) points, respectively; VAS scores at 12 h after operation were (3.21±0.64) and (3.00±0.66) points, respectively; the postoperative 1-hour Ramsay sedation scores were (3.82±0.66) and (3.21±0.57) points, respectively, and the postoperative 6-hour Ramsay scores were (2.65±0.48) and (2.31±0.46) points, respectively; at 3 d after operation, HAD-A scores were (10.53±1.86) and (9.94±1.73) points, respectively; HAD-D scores were (10.56±2.10) and (9.86±2.05) points, respectively; MMSE scores were (21.34±1.82) and (22.22±1.93) points, respectively; within 7 d after operation, the incidences of POD were 15.65% (18 cases/115 cases) and 6.84% (8 cases/117 cases), respectively; during anesthesia induction, the incidence of adverse drug reactions were 20.87% (24 cases/115 cases) and 9.40% (11 cases/117 cases), respectively. The differences of above indicators were all statistically significant comparing between the two group (P<0.05,P<0.01). The main adverse drug reactions during the anesthesia induction period in treatment group and control group included hypotension, hypertension, bradycardia and tachycardia.

Conclusion

Compared with the regimen of midazolam injection combined with propofol emulsion injection, the regimen of benzenesulfonate remimazolam for injection combined with esketamine hydrochloride injection for anesthesia induction can shorten recovery time, maintain stable hemodynamics, improve analgesic effect, relieve anxiety and depression, improve cognitive function, and have good safety.

Key words

benzenesulfonate remimazolam for injection / esketamine hydrochloride injection / total knee arthroplasty / anesthesia induction / clinical efficacy / safety

引用本文

魏纯利, 姚福旺, 冯雨林, 孙银贵. 瑞马唑仑联合艾司氯胺酮全麻诱导对老年严重膝骨关节炎患者全膝关节置换术后的临床研究. 中国临床药理学杂志, 2026 , 42 (9) : 1251 -1257 . DOI: 10.13699/j.cnki.1001-6821.2026.09.009

Chun-li WEI, Fu-wang YAO, Yu-lin FENG, Yin-gui SUN. Clinical trial of general anesthesia induction with remimazolam combined with esketamine in elderly patients with severe knee osteoarthritis after total knee arthroplasty[J]. Chinese Journal of Clinical Pharmacology, 2026 , 42 (9) : 1251 -1257 . DOI: 10.13699/j.cnki.1001-6821.2026.09.009

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2026年第42卷第9期

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doi: 10.13699/j.cnki.1001-6821.2026.09.009

接收时间：2026-01-12
首发时间：2026-08-06
出版时间：2026-05-17

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收稿日期：2026-01-12

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作者信息

^1.山东第二医科大学麻醉学院，山东潍坊 261053

^2.山东第二医科大学附属医院麻醉科，山东潍坊 261031

通讯作者:

孙银贵，主任医师，硕士生导师 MP: 13563666575 E-mail: m13061283582@163.com

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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