目的 研究全麻妇科手术中应用瑞马唑仑的麻醉效果，及对患者认知功能和应激反应的影响。方法 选取2021年1月至2022年12月于本院行全麻妇科手术的患者102例，随机分为丙泊酚组、瑞马唑仑组，各51例。丙泊酚组采用丙泊酚行麻醉诱导，静注瑞芬太尼、丙泊酚进行麻醉维持，瑞马唑仑组采用瑞马唑仑行麻醉诱导，静注瑞芬太尼、瑞马唑仑进行麻醉维持。比较两组手术时间及麻醉效果；比较两组围术期血流动力学指标、应激指标；比较两组术后认知功能、不良反应。结果 两组镇静成功率均为100%。丙泊酚组与瑞马唑仑组睫毛反射消失时间、NI值降至D0的时间、苏醒时间比较，经t检验，差异有统计学意义（t=14.986，P=0.000；t=10.774，P=0.000；t=3.895，P=0.000），丙泊酚组睫毛反射消失时间、NI值降至D0的时间均短于瑞马唑仑组，苏醒时间长于瑞马唑仑组。丙泊酚组与瑞马唑仑组手术开始后30 min、手术结束时平均动脉压（MAP）比较，经t检验，差异有统计学意义（t=3.006，P=0.003；t=2.338，P=0.021），丙泊酚组低于瑞马唑仑组。丙泊酚组与瑞马唑仑组术前、手术结束时、术后48 h血清促肾上腺皮质激素（ACTH）、醛固酮（ALD）水平比较，经t检验，差异无统计学意义（P＞0.05）。丙泊酚组与瑞马唑仑组术后认知功能障碍、注射痛、呼吸抑制发生率比较，经Fisher精确检验，差异有统计学意义（P=0.028、0.027、0.028），丙泊酚组均高于瑞马唑仑组。结论 相较于丙泊酚，瑞马唑仑应用于全麻妇科手术中起效较慢，但对血流动力学、认知功能影响较小，且安全性更高，在麻醉效果及应激反应上两者效果相当。
Objective To study the anesthetic effect of midazolam in general anesthesia gynecological surgery and its effect on patients’ cognitive function and stress response. Methods 102 patients who underwent general anesthesia gynecological surgery in our hospital from January 2021 to December 2022 were selected and randomly divided into propofol group and remazolam group, with 51 cases in each group. propofol group used propofol for anesthesia induction, intravenous infusion of remifentanil and propofol for anesthesia maintenance, remazolam group used midazolam for anesthesia induction, intravenous infusion of remifentanil and midazolam for anesthesia maintenance. The operation time and anesthetic effect of the two groups were compared. The perioperative hemodynamic indicators and stress indicators of the two groups were compared. The postoperative cognitive function and adverse reactions of the two groups were compared. Results The sedation success rate of both groups was 100%. The eyelash reflex disappearance time, NI value decreased to D0 time, and recovery time of propofol group and remazolam group were compared by t-test, and the differences were statistically significant (t=14.986, P=0.000; t=10.774, P=0.000; t=3.895，P=0.000), eyelash reflex disappearance time, NI value decreased to D0 time of propofol group were shorter than those of remazolam group, recovery time was longer than that of remazolam group. The mean arterial pressure (MAP) at 30 min after the start of surgery and at the end of surgery in propofol group and remazolam group were compared by t-test, and the differences were statistically significant (t=3.006, P=0.003; t=2.338, P=0.021), which of propofol group was lower than that of remazolam group. The serum adrenocorticotropic hormone (ACTH) and aldosterone (ALD) levels before surgery, at the end of surgery, and 48 h after surgery in propofol group and remazolam group were compared by t-test, and the difference was not statistically significant (P>0.05). The incidence of postoperative cognitive dysfunction, injection pain, and respiratory depression in propofol group and remazolam group were compared by Fisher’s exact test, and the differences were statistically significant (P=0.028, 0.027, 0.028), which of propofol group was higher than those of remazolam group. Conclusion Compared with propofol, Remazolam has a slower effect in gynecological surgery under general anesthesia, but has less impact on hemodynamics and cognitive function, and has higher safety. The two effects are similar in anesthetic effect and stress response.