Protective Effect Of Remimazolam On Liver Oxidative Stress Injury Of Patients Undergoing Laparoscopic Cholecystectomy

Objective To investigate the protective effect of remimazolam induction and maintenance of general anesthesia on liver oxidative stress injury in patients undergoing laparoscopic cholecystectomy.Methods Sixty patients who underwent laparoscopic cholecystectomy in a third grade a hospital were selected and divided into study group and control group according to the random number table method,with 30 cases in each group.All subjects were collected from fasting venous blood 5ml before and 24 hours after surgery,serum ALT,AST,TBIL levels,and serum MDA,SOD and GSH-Px levels.The changes of blood pressure and heart rate before operation（T₀）,immediately after intubation（T₁）,immediately after pneumoperitoneum（T₂）and immediately after extubation（T₃）,recovery time and incidence of adverse reactions were recorded.Results Before operation,SOD was355.86±36.11U/m L in the experimental group and 359.31±28.92U/m L in the control group,with no statistically significant difference between the two groups（t=2.881,P=0.629）.The MDA of the experimental group was 12.93±1.78nmol/L,while that of the control group was 13.79±1.26nmol/L,with no significant difference between the two groups（t=1.127,P=0.351）.GSH-Px was 1103.73±146.58U in the experimental group and 1167.82±130.42U in the control group,and there was no significant difference between the two groups（t=1.894,P=0.063）.SOD was317.62±37.72U/m L in the experimental group and 270.91±31.75U/m L in the control group,the difference was statistically significant（t=3.925,P=0.001）.The MDA of the experimental group was 19.05±1.74nmol/L,and that of the control group was28.02±1.34nmol/L,the difference was statistically significant（t=28.123,P=0.001）.GSH-Px was 974.34±158.55U in the experimental group and 856.55±110.38U in the control group,the difference between the two groups was statistically significant（t=3.4399,P=0.001）.Compared with pre-operation,SOD in the experimental group decreased significantly after operation,with statistical significance（t=3.751,P=0.001）.MDA was significantly increased,and the difference was statistically significant（t=12.265,P=0.001）.GSH-Px was significantly decreased,and the difference was statistically significant（t=5.806,P=0.001）.Compared with the control group before operation,SOD decreased significantly after operation,with statistical significance（t=15.438,P=0.001）.MDA was significantly increased,and the difference was statistically significant（t=48.086,P=0.001）.GSH-Px was significantly decreased,and the difference was statistically significant（t=10.178,P=0.001）.Before operation,SOD was 355.86±36.11U/m L in the experimental group and 359.31±28.92U/m L in the control group,with no statistically significant difference between the two groups（t=2.881,P=0.629）.The MDA of the experimental group was 12.93±1.78nmol/L,while that of the control group was13.79±1.26nmol/L,with no significant difference between the two groups（t=1.127,P=0.351）.GSH-Px was 1103.73±146.58U in the experimental group and1167.82±130.42U in the control group,and there was no significant difference between the two groups（t=1.894,P=0.063）.SOD was 317.62±37.72U/m L in the experimental group and 270.91±31.75U/m L in the control group,the difference was statistically significant（t=3.925,P=0.001）.The MDA of the experimental group was 19.05±1.74nmol/L,and that of the control group was 28.02±1.34nmol/L,the difference was statistically significant（t=28.123,P=0.001）.GSH-Px was974.34±158.55U in the experimental group and 856.55±110.38U in the control group,the difference between the two groups was statistically significant（t=3.4399,P=0.001）.Compared with pre-operation,SOD in the experimental group decreased significantly after operation,with statistical significance（t=3.751,P=0.001）.MDA was significantly increased,and the difference was statistically significant（t=12.265,P=0.001）.GSH-Px was significantly decreased,and the difference was statistically significant（t=5.806,P=0.001）.Compared with the control group before operation,SOD decreased significantly after operation,with statistical significance（t=15.438,P=0.001）.MDA was significantly increased,and the difference was statistically significant（t=48.086,P=0.001）.GSH-Px was significantly decreased,and the difference was statistically significant（t=10.178,P=0.001）.There was no statistically significant difference in heart rate at T₀,T₁,T₂and T₃（F=2.206,P=0.091）,systolic blood pressure at each time（F=2.119,P=0.102）,and diastolic blood pressure at each time（F=1.769,P=0.157）.In the control group,there was no statistically significant difference in heart rate at T₀,T₁,T₂and T₃（F=0.607,P=0.612）,systolic blood pressure at each time（F=2.226,P=0.089）,and diastolic blood pressure at each time（F=1.976,P=0.121）.Injection pain occurred in the experimental group in 1 case（3.33%）and the control group in 13 cases（43.33%）.There was a significant difference in the incidence of injection pain between the two groups（~213.416,P=0.001）.The incidence of nausea and vomiting was significantly different between the two groups（~2=9.231,P=0.002）,with 0（0%）in the experimental group and 8（26.67%）in the control group.There was no significant difference in the incidence of respiratory depression between the two groups（~2=3.268,P=0.145）.There was 1 case of irritability in the experimental group（3.33%）and 3 cases of irritability in the control group（10%）.There was no significant difference in the incidence of irritability between the two groups（~2=1.071,P=0.612）.The postoperative VAS score of the experimental group was1.17±0.46,and that of the control group was 1.60±1.32.There was no significant difference between the two groups（t=1.472,P=0.141）.Conclusion The use of remazolam to induce and maintain anesthesia during laparoscopic cholecystectomy can reduce MDA level,increase SOD and GSH-Px levels,reduce the incidence of abnormal postoperative AST,ALT and TBIL,and have a certain protective effect on liver oxidative stress injury caused by pneumoperitoneum,with fewer adverse reactions.