探讨瑞马唑仑联合右美托咪定滴鼻在小儿腹腔镜疝囊高位结扎术中的麻醉效果及安全性。

本研究为回顾性队列研究。回顾性分析2025年3—12月在西安市儿童医院行腹腔镜疝囊高位结扎术的201例腹股沟斜疝患儿的临床资料。根据麻醉方案将患者分为试验组（n=101）和对照组（n=100）。试验组采用瑞马唑仑联合右美托咪定滴鼻麻醉，对照组采用丙泊酚联合右美托咪定滴鼻麻醉。对比2组麻醉诱导前（T₀）、诱导后5 min（T₁）、手术开始5 min（T₂）、术毕（T₃）各时间段患者的心率、平均动脉压（MAP）、血氧饱和度（SpO₂）、麻醉诱导时间、苏醒时间、麻醉恢复室（PACU）停留时间及麻醉相关不良反应情况。

重复测量方差分析显示：2组患儿不同时间点的心率、MAP的波动幅度的组间效应（F_组间=5.824、3.837，P_组间=0.005、0.015）、时间效应（F_时间=2.975、7.387，P_时间=0.018、0.006）及交互效应（F_交互=3.718、3.539，P_交互=0.002、0.025）比较，差异均有统计学意义；进一步采用Bonferonni法校正进行简单效应分析中的两两比较结果，发现与T0对比，2组T1时心率、MAP下降，T2、T3时升高，但试验组各时间点心率、MAP波动幅度均小于对照组，差异有统计学意义（P<0.05）。SpO₂组间效应（F_组间=2.141，P_组间=0.061）、时间效应（F_时间=6.264，P_时间=0.089）及交互效应（F_交互=2.911，P_交互=0.117）比较，差异均无统计学意义（P>0.05）。试验组麻醉诱导时间、苏醒时间、PACU停留时间均短于对照组（t=2.362、19.634、2.259，P均<0.05）。试验组与对照组患儿麻醉相关不良反应总发生率比较（7.92%比10.00%），差异无统计学意义（χ²=0.266，P=0.606）。

瑞马唑仑联合右美托咪定滴鼻用于小儿腹腔镜疝囊高位结扎术，麻醉起效快、苏醒迅速，能稳定围手术期血流动力学，不良反应发生率低，安全性高。

To explore the anesthetic effect and safety of remimazolam combined with dexmedetomidine nasal drops in pediatric laparoscopic high ligation of hernia sac surgery.

This study was a retrospective cohort study. We retrospectively analyzed the clinical data of 201 children with indirect inguinal hernia who underwent laparoscopic high ligation of the hernial sac at Xi'an Children's Hospital from March to December 2025. The patients were divided into an experimental group (n=101) and a control group (n=100) according to the anesthesia regimen. The experimental group received remimazolam combined with dexmedetomidine nasal drops for anesthesia, while the control group received propofol combined with dexmedetomidine nasal drops for anesthesia. The heart rate, mean arterial pressure (MAP), oxygen saturation (SpO₂), anesthesia induction time, recovery time, length of stay in the post-anesthesia care unit (PACU), and anesthesia-related adverse reactions were compared between the two groups at four time points: before anesthesia induction (T₀), 5 minutes after induction (T₁), 5 minutes after the start of surgery (T₂), and at the end of surgery (T₃).

Repeated-measures analysis of variance showed that there were statistically significant differences in the fluctuation ranges of heart rate and MAP between the two groups of children at different time points in terms of inter-group effect (F_group=5.824, 3.837; P_group=0.005, 0.015), time effect (F_time=2.975, 7.387; P_time=0.018, 0.006), and interaction effect (F_interaction=3.718, 3.539; P_interaction=0.002, 0.025). Further pairwise comparisons with Bonferroni correction in simple effect analysis revealed that, compared with T0, heart rate and MAP decreased at T1 and increased at T2 and T3 in both groups. However, the fluctuation ranges of heart rate and MAP at all time points in the experimental group were significantly smaller than those in the control group (P<0.05). For SpO₂, there were no statistically significant differences in the inter-group effect (F_group=2.141, P_group=0.061), time effect (F_time=6.264, P_time=0.089), and interaction effect (F_interaction=2.911, P_interaction=0.117) (all P>0.05). The anesthesia induction time, awakening time, and PACU stay time in the experimental group were shorter than those in the control group (t=2.362, 19.634, 2.259; all P<0.05). There was no statistically significant difference in the total incidence of anesthesia-related adverse reactions between the experimental group and the control group (7.92% vs 10.00%; χ²=0.266, P=0.606).

Remimazolam combined with dexmedetomidine nasal drops is used for pediatric laparoscopic high ligation of hernia sacs. The anesthetic effect is rapid, the recovery is swift, it can stabilize the perioperative hemodynamics, the incidence of adverse reactions is low, and the safety is high.