Comparison Of Effects Of Remazolam And Propofol On Short-term Postoperative Fatigue Syndrome In Patients Undergoing Gastrointestinal Tumor Surgery

Objective:Postoperative Fatigue Syndrome（POFS）refers to the continuous period of fatigue that patients feel subjectively after operations.It is an extremely common group of symptoms in clinical postoperative recovery,commonly occurring after various operations.There are even reports of fatigue symptoms of varying degrees 24 to 36months after surgery.As a new benzodiazepine sedative and hypnotic drug,remazolam has been widely accepted,which has less impact on respiratory and circulatory function,rapid recovery and comfort,etc.The purpose of this study was to compare the differences between remazolam and propofel in the incidence and degree of postoperative fatigue syndrome in gastrointestinal surgery patients,and to explore the correlation between stress response and nutritional status and postoperative fatigue syndrome.To provide a theoretical basis for preventing or reducing postoperative fatigue syndrome and a reasonable scheme for clinical anesthesia.Methods:Sixty patients undergoing elective gastrointestinal surgery were enrolled strictly according to the criteria,with ASA from Grade I to Grade III,ages from 30 to 65years old,BMI from 18 to 24 kg/m²,and the same team of surgeons.Patients were randomly divided into two groups by random number table method:propofol induction maintenance group（Group P）and remazolam induction maintenance group（Group R）,with 30 cases in each group.Vital signs were recorded before induction（T0）,1 min after induction（T1）,immediately after endotracheal intubation（T2）,at the time of leaving the operating room（T3）,and at the time of leaving the anesthesia recovery room（T4）,including HR,MAP,BIS and Sp O₂.Visual analog pain scale（VAS）was used to score pain severity 1 day before elective surgery（D0）,1 day after surgery（D1）,and 3 days after surgery（D3）.Christensen Postoperative Fatigue Assessment Scale,Perioperative Fatigue Assessment Scale（ICFS）,Fatigue Scale-14（FS-l4）and Profile of Mood States（BPOMS）were used to evaluate the degree of postoperative fatigue.Meanwhile,peripheral venous blood of the patients was collected to measure the concentration of stress indicators（adrenaline,norepinephrine,cortisol）,and blood biochemical results（albumin,prealbumin,total protein,glucose）were recorded.The recovery time and condition of the patients were recorded,and the sedation level was evaluated using the Sedation-Agitation Scale（SAS）when the tracheal catheter was removed.Results:General information:There were no significant differences in age,gender composition,BMI,surgical site composition,ASA grading and comorbidities between the two groups（P>0.05）.Operation conditions:There were no statistical differences in operation time,anesthesia time,intraoperative blood loss,urine volume and infusion volume between the two groups（P>0.05）.The average induction time of Group R was longer than that of Group P（P<0.05）.But the eye opening time and extubation time were shorter than those in Group P,and the SAS score was lower（P<0.05）.Perioperative vital signs:there were no significant differences in HR,MAP and BIS between the two groups at T0（P>0.05）.HR,MAP and BIS in two groups at T1were lower than those at T0（P<0.05）,and HR,MAP and BIS in Group R were higher than those in Group P（P<0.05）.The incidence of perioperative cardiovascular event（hypotension,sinus bradycardia）in Group R was significantly lower than that in Group P（P<0.05）.Stress indexes:There were no significant differences in plasma E,NE,Cor and Glu levels between the two groups at D0（P>0.05）.The plasma levels of E,NE,Cor and Glu in D1 and D3 were significantly higher than those in T0（P<0.05）,and the plasma levels of E,NE and Cor in Group R were lower than those in Group P（P<0.05）.Nutritional indexes:There were no significant differences in plasma TP,ALB and PA levels between the two groups at D0（P>0.05）.The levels of plasma TP,ALB and PA in two groups at D0 were significantly lower than those at D1 and D3（P<0.05）.The level of plasma TP in Group R was lower than that in Group P at D1,and the level of plasma PA in Group R was lower than that in Group P at D1 and D3（P<0.05）.Postoperative fatigue evaluation:there was no significant difference in fatigue scale evaluation results between the two groups at D0（P>0.05）.The postoperative fatigue degree of patients was evaluated by Christensen Postoperative Fatigue Assessment Scale,Perioperative Fatigue Assessment Scale（ICFS）,Fatigue Scale-14（FS-l4）and Profile of Mood States（BPOMS）.Fatigue scores in D1 and D3were higher than those in D0（P<0.05）.The score of Group R was significantly lower than that of Group P（P<0.05）.Conclusion:This study found that the use of remazolam in general anesthesia for gastrointestinal tumor surgery can reduce the degree of POFS within 3 days after surgery by reducing stress response,and verified that remazolam’s sedative and hypnotic effect is not inferior to propofol,and has less influence on circulation function,shorter and more comfortable recovery,which is conducive to accelerating postoperative rehabilitation of patients,and is worth popularizing.