中国临床药理学杂志

咪达唑仑联合丙泊酚在重度肥胖患者胃切除术中的临床研究

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马擎 ^1a , 李莉 ^1a , 朱珊珊 ^1a , 王巧妍 ^1a , 陈浩 ^1b

中国临床药理学杂志 | 临床与基础桥接研究 2025,41(17): 2429-2434

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中国临床药理学杂志 |临床与基础桥接研究 2025 , 41 (17) : 2429 -2434

咪达唑仑联合丙泊酚在重度肥胖患者胃切除术中的临床研究

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马擎^1a, 李莉^1a, 朱珊珊^1a, 王巧妍^1a, 陈浩^1b

作者信息

^1a.徐州医科大学附属医院，麻醉科，江苏徐州 221000

^1b.徐州医科大学附属医院，神经内科，江苏徐州 221000

通讯作者:

陈浩，主任医师 MP: 13685173610 E-mail: chenhao2594@126.com

作者简介:

马擎（1985-），女，副主任医师，主要从事术中镇痛及术后患者认知变化方面的临床工作和研究

Clinical trial of midazolam combined with propofol in severely obese patients undergoing gastrectomy

Qing MA^1a, Li LI^1a, Shan-shan ZHU^1a, Qiao-yan WANG^1a, Hao CHEN^1b

Affiliations

^1a.Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China

^1b.Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China

出版时间: 2025-09-17 doi: 10.13699/j.cnki.1001-6821.2025.17.006

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摘要

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目的

观察咪达唑仑注射液联合丙泊酚中/长链脂肪乳注射液靶控输注（TCI）对重度肥胖患者行腹腔镜下袖状胃切除联合双通路吻合术（LSG-DJB）的临床疗效及安全性。

方法

将本院就诊的重度肥胖患者按随机数表法分为对照组和试验组。对照组用丙泊酚中/长链脂肪乳注射液TCI（效应室浓度1.2~2.0 μg·mL^-1）进行麻醉，试验组在对照组基础上联合咪达唑仑注射液（0.03 mg·kg^-1诱导，0.02 mg·kg^-1·h^-1维持）进行麻醉。比较2组患者的疼痛指标、苏醒质量、炎症指标和氧化应激指标，并评价安全性。

结果

本研究共筛选179例患者，其中对照组和试验组分别入组67例和68例。对照组脱落3例，试验组脱落4例，最终对照组和试验组各完成64例。试验组和对照组的离室时疼痛评分（NRS）分别为（0.76±0.42）和（0.93±0.28）分，术后6 h分别为（1.94±0.46）和（2.37±0.82）分，术后12 h分别为（2.24±0.51）和（2.92±0.71）分，试验组的上述指标与对照组比较，在统计学上差异均有统计学意义（均P<0.05）。试验组和对照组的术中舒芬太尼注射液总用量分别为（0.75±0.12）和（0.92±0.15）μg·kg^-1；睁眼时间分别为（10.77±1.48）和（8.39±1.23）min；拔管时间分别为（18.68±2.91）和（13.21±2.48）min；呼吸恢复时间分别为（16.87±2.25）和（11.93±2.03）min，试验组的上述指标与对照组比较，在统计学上差异均有统计学意义（均P<0.05）。术后24 h，试验组和对照组的血清白细胞介素-6（IL-6）水平分别为（72.16±10.28）和（88.32±11.14）ng·L^-1，肿瘤坏死因子-α（TNF-α）分别为（152.47±21.95）和（176.84±25.67）ng·L^-1，C-反应蛋白（CRP）分别为（5.63±0.88）和（7.74±0.86）mg·L^-1，丙二醛（MDA）分别为（4.82±1.19）和（7.03±1.22）mmol·mL^-1，皮质醇（Cor）分别为（31.42±3.27）和（37.75±4.16）μg·dL^-1，超氧化物歧化酶（SOD）分别为（37.38±5.82）和（23.67±3.59）mmol·mL^-1，试验组的上述指标与对照组比较，在统计学上差异均有统计学意义（均P<0.05）。试验组药物不良反应主要表现为低氧血症、低血压、苏醒延迟及恶心呕吐；对照组则以恶心呕吐、低氧血症及低血压为主。试验组和对照组药物不良反应总发生率分别为54.69%和42.19%，在统计学上差异无统计学意义（P>0.05）。

结论

咪达唑仑注射液联合丙泊酚中/长链脂肪乳注射液TCI麻醉可优化重度肥胖患者LSG-DJB术中的镇静深度，降低炎症与应激水平，且安全性良好。

关键词

咪达唑仑注射液 / 丙泊酚中/长链脂肪乳注射液 / 重度肥胖 / 腹腔镜袖状胃切除 / 双通路吻合术 / 靶控输注

Abstract

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Objective

To investigate the clinical efficacy and safety of midazolam injection combined with propofol medium/long-chain fat emulsion target-controlled infusion (TCI) in severely obese patients undergoing laparoscopic sleeve gastrectomy with double-tract anastomosis (LSG-DJB).

Methods

Severely obese patients treated in our hospital were randomly assigned by a random number table method to the control group or the treatment group. The control group received propofol medium/long-chain fat emulsion TCI (effect-site concentration 1.2–2.0 μg·mL^-1), while the treatment group additionally received midazolam injection (0.03 mg·kg^-1 for induction, 0.02 mg·kg^-1·h^-1 for maintenance). Pain indicators, recovery quality, inflammatory markers, oxidative stress parameters and safety outcomes were compared between the two groups.

Results

A total of 179 patients were screened in this study, with 67 cases enrolled in the control group and 68 cases in the treatment group. Three cases dropped out in the control group and four cases dropped out in the treatment group; ultimately, 64 cases in each group completed the study. The pain scores (NRS) at discharge from the operating room were (0.76±0.42) and (0.93±0.28) points for the treatment group and control group, respectively; at 6 hours postoperatively, they were (1.94±0.46) and (2.37±0.82) points, respectively; at 12 hours postoperatively, they were (2.24±0.51) and (2.92±0.71) points, respectively. Compared with the control group, the differences in the above indicators in the treatment group were statistically significant (all P<0.05). The total intraoperative dosage of sufentanil injection were (0.75±0.12) and (0.92±0.15) μg·kg^-1 for the treatment group and control group, respectively; the eye-opening time was (10.77±1.48) and (8.39±1.23) min, respectively; the extubation time was (18.68±2.91) and (13.21±2.48) min, respectively; the respiratory recovery time was (16.87±2.25) and (11.93±2.03) min, respectively. Compared with the control group, the differences in the above indicators in the treatment group were statistically significant (all P<0.05). At 24 hours postoperatively, the serum interleukin-6 (IL-6) levels were (72.16±10.28) and (88.32±11.14) ng·L^-1 for the treatment group and control group, respectively; tumor necrosis factor-α (TNF-α) levels were (152.47±21.95) and (176.84±25.67) ng·L^-1, respectively; C-reactive protein (CRP) levels were (5.63±0.88) and (7.74±0.86) mg·L^-1, respectively; malondialdehyde (MDA) levels were (4.82±1.19) and (7.03±1.22) mmol·mL^-1, respectively; cortisol (Cor) levels were (31.42±3.27) and (37.75±4.16) μg·dL^-1, respectively; superoxide dismutase (SOD) levels were (37.38±5.82) and (23.67±3.59) mmol·mL^-1, respectively. Compared with the control group, the differences in the above indicators in the treatment group were statistically significant (all P<0.05). The main adverse drug reactions in the treatment group were hypoxemia, hypotension, delayed recovery, nausea and vomiting; the main adverse reactions in the control group were nausea and vomiting, hypoxemia, and hypotension. The total incidence rates of adverse drug reactions were 54.69% and 42.19% in the treatment group and control group, respectively, with no statistically significant difference (P>0.05).

Conclusion

Midazolam injection combined with propofol medium/long-chain fat emulsion TCI provides optimized sedation depth, reduces inflammatory and stress responses, and demonstrates good safety in severely obese patients undergoing LSG-DJB.

Key words

midazolam injection / propofol medium/long-chain fat emulsion injection / severe obesity / laparoscopic sleeve gastrectomy / double-tract anastomosis / target-controlled infusion

引用本文

马擎, 李莉, 朱珊珊, 王巧妍, 陈浩. 咪达唑仑联合丙泊酚在重度肥胖患者胃切除术中的临床研究. 中国临床药理学杂志, 2025 , 41 (17) : 2429 -2434 . DOI: 10.13699/j.cnki.1001-6821.2025.17.006

Qing MA, Li LI, Shan-shan ZHU, Qiao-yan WANG, Hao CHEN. Clinical trial of midazolam combined with propofol in severely obese patients undergoing gastrectomy[J]. Chinese Journal of Clinical Pharmacology, 2025 , 41 (17) : 2429 -2434 . DOI: 10.13699/j.cnki.1001-6821.2025.17.006

基金

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江苏省重点研发计划基金资助项目(BE2022049)

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2025年第41卷第17期

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文章信息

doi: 10.13699/j.cnki.1001-6821.2025.17.006

接收时间：2025-06-09
首发时间：2026-08-05
出版时间：2025-09-17

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收稿日期：2025-06-09

基金

江苏省重点研发计划基金资助项目(BE2022049)

作者信息

^1a.徐州医科大学附属医院，麻醉科，江苏徐州 221000

^1b.徐州医科大学附属医院，神经内科，江苏徐州 221000

通讯作者:

陈浩，主任医师 MP: 13685173610 E-mail: chenhao2594@126.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
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