瑞马唑仑稳定诱导期血流动力学但未降低腹腔镜肾部分切除术后肾损伤风险：一项倾向性评分匹配的回顾性队列研究

doi:10.12122/j.issn.1673-4254.2026.09.07

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (9): 2069-2077.doi: 10.12122/j.issn.1673-4254.2026.09.07

• • 上一篇

瑞马唑仑稳定诱导期血流动力学但未降低腹腔镜肾部分切除术后肾损伤风险：一项倾向性评分匹配的回顾性队列研究

孙嫦红¹(), 刘飞¹, 李佳馨², 高涵², 刘毅², 徐龙河², 刘永哲²(), 高明龙¹^,³()

^1.山西医科大学麻醉学院，山西太原 030001
^2.解放军总医院第三医学中心麻醉科，北京 100039
^3.解放军总医院海南医院疼痛科，海南三亚 572013

收稿日期:2026-02-03 出版日期:2026-09-20 发布日期:2026-09-30
通讯作者: 刘永哲,高明龙 E-mail:16634250625@163.com;lyzgao@163. com;gaominglongg@163.com
作者简介:孙嫦红，在读硕士研究生，E-mail: 16634250625@163.com
基金资助:
首都卫生发展科研专项(2020-2-5092);北京市科技委员会资助项目(Z1711000000417035)

Remimazolam stabilizes hemodynamics during anesthesia induction but fails to reduce renal injury risk following laparoscopic partial nephrectomy: a propensity score-matched retrospective cohort study

Changhong SUN¹(), Fei LIU¹, Jiaxin LI², Han GAO², Yi LIU², Longhe XU², Yongzhe LIU²(), Minglong GAO¹^,³()

^1.School of Anesthesiology, Shanxi Medical University, Taiyuan 030001, China
^2.Department of Anesthesiology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
^3.Department of Pain Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China

Received:2026-02-03 Online:2026-09-20 Published:2026-09-30
Contact: Yongzhe LIU, Minglong GAO E-mail:16634250625@163.com;lyzgao@163. com;gaominglongg@163.com

摘要/Abstract

摘要：

目的研究全麻诱导期使用瑞马唑仑对腹腔镜下肾部分切除术患者血流动力学及术后肾功能的影响。方法回顾性分析2022年1月~2024年12月解放军总医院第三医学中心收治的265例接受腹腔镜下肾部分切除术（LPN）的肾肿瘤患者的临床资料。根据麻醉诱导是否使用0.2 mg/kg瑞马唑仑将患者分为对照组和瑞马唑仑组，经倾向性评分匹配后，最终纳入130例，65例/组。收集患者麻醉诱导前10 min（T₀）、诱导完成后即刻（T₁）、气管插管完成后（T₂）、气管插管后10 min（T₃）的平均动脉压（MAP）及心率（HR），收集患者术后24 h肾功能指标，并比较两组患者术后急性肾损伤（AKI）的发病率。根据术前和术后24 h血肌酐（sCr）和胱抑素（Cys-C），计算估计肾小球滤过率eGFRsCr、eGFRCys-C与eGFRdiff 值。在130例患者中收集到77例术后3个月~1年的eGFRsCr，其中对照组36例，瑞马唑仑组41例，比较两组患者慢性肾脏病（CKD）的发病率以及AKI与CKD的相关性。结果经倾向性评分匹配和显著协变量调整后，瑞马唑仑组 T3 ∆MAP［-20.11±11.65 mmHg vs -13.54±12.75 mmHg，P<0.05］及 T2 ∆HR［-3.78±11.18 次/min vs 2.82±10.79 次/min，P<0.05］、T3 ∆ HR［-10.85±15.54 次/min vs -3.35±11.67 次/min，P<0.05］变化小于对照组；瑞马唑仑组术后Cys-C高于对照组［0.91（0.77，1.01）vs 0.96（0.96，1.03），P<0.05］；瑞马唑仑组术后24 h eGFRCys-C低于对照组（94.83±20.92 vs 83.65±9.84，P<0.05）；瑞马唑仑组eGFRdiff 比对照组呈负向变化（18.55±17.06 vs 8.52±15.85，P<0.05）；其余指标差异均无统计学意义（P>0.05）；AKI与CKD呈正相关（P<0.05）。结论与丙泊酚相比，诱导时使用瑞马唑仑可提高麻醉诱导期血流动力学的稳定性，未降低LPN术后AKI和CKD的发病率。

关键词: 瑞马唑仑, 肾部分切除术, 血流动力学, Cys-C, 急性肾损伤, 慢性肾脏病, 倾向性评分匹配

Abstract:

Objective To investigate the effects of remimazolam administered during anesthesia induction on hemodynamics and postoperative renal function in patients undergoing laparoscopic partial nephrectomy (LPN). Methods Clinical data of 265 renal tumor patients undergoing LPN between January, 2022 and December, 2024 were collected. The patients were divided into control group and remimazolam group (0.2 mg/kg for induction), and after propensity score matching (PSM), 65 patients in each group were included. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (T₀), immediately after induction (T₁), immediately after intubation (T₂), and 10 min after intubation (T₃). Renal function indicators at 24 h postoperatively and incidences of acute kidney injury (AKI) were recorded. Estimated glomerular filtration rates (eGFRsCr, eGFRCys-C, and eGFRdiff) were calculated using serum creatinine (sCr) and cystatin C (Cys-C). From 36 patients in control group and 41 patients in remimazolam group followed up for 3-12 months, eGFRsCr data were collected to evaluate the incidence of chronic kidney disease (CKD) and analyze its correlation with AKI. Results After PSM and covariate adjustment, remimazolam group showed significantly smaller changes than control group in ΔMAP at T3 (-20.11±11.65 vs -13.54±12.75 mmHg, P<0.05), ΔHR at T2 (-3.78±11.18 vs 2.82±10.79 min^-1, P<0.05), and ΔHR at T3 (-10.85±15.54 vs -3.35±11.67 min^-1, P<0.05). The remimazolam group showed significantly higher postoperative Cys-C level than the control group [0.96 (0.96, 1.03) vs 0.91 (0.77, 1.01), P<0.05] but lower eGFRCys-C at 24 h (83.65±9.84 vs 94.83±20.92, P<0.05). eGFRdiff showed a significant negative shift in remimazolam group (18.55±17.06 vs 8.52±15.85, P<0.05). Other indicators did not differ significantly between the two groups. AKI showed a significant correlation with CKD following LPN (P<0.05). Conclusion Compared with propofol, remimazolam induction improves hemodynamic stability during anesthesia induction but does not reduce the incidences of postoperative AKI or CKD after LPN.

Key words: remimazolam, partial nephrectomy, hemodynamics, Cystatin C, acute kidney injury, chronic kidney disease, propensity score matching

孙嫦红, 刘飞, 李佳馨, 高涵, 刘毅, 徐龙河, 刘永哲, 高明龙. 瑞马唑仑稳定诱导期血流动力学但未降低腹腔镜肾部分切除术后肾损伤风险：一项倾向性评分匹配的回顾性队列研究[J]. 南方医科大学学报, 2026, 46(9): 2069-2077.

Changhong SUN, Fei LIU, Jiaxin LI, Han GAO, Yi LIU, Longhe XU, Yongzhe LIU, Minglong GAO. Remimazolam stabilizes hemodynamics during anesthesia induction but fails to reduce renal injury risk following laparoscopic partial nephrectomy: a propensity score-matched retrospective cohort study[J]. Journal of Southern Medical University, 2026, 46(9): 2069-2077.

图/表 9

参考文献 39

[1]	Zhao PT, Richstone L, Kavoussi LR. Laparoscopic partial nephrectomy[J]. Int J Surg, 2016, 36: 548-53. doi：10.1016/j.ijsu.2016.04.028
[2]	Wu QF, Kong H, Xu ZZ, et al. Impact of goal-directed hemodynamic management on the incidence of acute kidney injury in patients undergoing partial nephrectomy: a pilot randomized controlled trial[J]. BMC Anesthesiol, 2021, 21(1): 67. doi：10.1186/s12871-021-01288-8
[3]	Kurzhagen JT, Dellepiane S, Cantaluppi V, et al. AKI: an increasingly recognized risk factor for CKD development and progression[J]. J Nephrol, 2020, 33(6): 1171-87. doi：10.1007/s40620-020-00793-2
[4]	Ostermann M, Lumlertgul N, Jeong R, et al. Acute kidney injury[J]. Lancet, 2025, 405(10474): 241-56. doi：10.1016/s0140-6736(24)02385-7
[5]	Patidar KR, Ma AT, Juanola A, et al. Global epidemiology of acute kidney injury in hospitalised patients with decompensated cirrhosis: the International Club of Ascites GLOBAL AKI prospective, multicentre, cohort study [J]. Lancet Gastroenterol Hepatol, 2025, 10(5): 418-30.
[6]	Zhang L, Yang J, Zhou L, et al. The use of remimazolam versus propofol for anesthesia induction in video-assisted thoracoscopic surgery: study protocol for a multicenter randomized controlled trial[J]. Trials, 2025, 26(1): 173. doi：10.1186/s13063-025-08833-7
[7]	Chen M, Zhang DY. Machine learning-based prediction of post-induction hypotension: identifying risk factors and enhancing anesthesia management[J]. BMC Med Inform Decis Mak, 2025, 25(1): 96. doi：10.1186/s12911-025-02930-y
[8]	Maheshwari K, Turan A, Mao G, et al. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis[J]. Anaesthesia, 2018, 73(10): 1223-8. doi：10.1111/anae.14416
[9]	Chen EY, Michel G, Zhou B, et al. An analysis of anesthesia induction dosing in female older adults[J]. Drugs Aging, 2020, 37(6): 435-46. doi：10.1007/s40266-020-00760-3
[10]	Dai GR, Pei LL, Duan FY, et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia[J]. Minerva Anestesiol, 2021, 87(10): 1073-9. doi：10.23736/s0375-9393.21.15517-8
[11]	Doi M, Hirata N, Suzuki T, et al. Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA Class III): results of a multicenter, randomized, double-blind, parallel-group comparative trial[J]. J Anesth, 2020, 34(4): 491-501. doi：10.1007/s00540-020-02776-w
[12]	Doi M, Morita K, Takeda J, et al. Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial[J]. J Anesth, 2020, 34(4): 543-53. doi：10.1007/s00540-020-02788-6
[13]	Xing Y, Lang ZK, Wang XR, et al. Anesthetic efficacy with remimazolam compared with propofol: a systematic review and meta-analysis of randomized controlled trials[J]. Int J Surg, 2025, 111(9): 6384-96. doi：10.1097/js9.0000000000002737
[14]	Matsumoto S, Ukon Y, Endo S, et al. Antioxidative activity of remimazolam as a direct free radical scavenger in comparison with midazolam[J]. Cureus, 2025: 94676-88. doi：10.7759/cureus.94676
[15]	Tsukimoto S, Kitaura A, Kuroda H, et al. Anti-inflammatory potential of remimazolam: a laboratory and clinical investigation[J]. Immunity Inflam Disease, 2024, 12(3): e1218. doi：10.1002/iid3.1218
[16]	Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate[J]. Ann Intern Med, 2009, 150(9): 604-12. doi：10.7326/0003-4819-150-9-200905050-00006
[17]	Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C[J]. N Engl J Med, 2012, 367(1): 20-9. doi：10.1056/nejmoa1114248
[18]	Jessup M, Costanzo MR. The cardiorenal syndrome[J]. J Am Coll Cardiol, 2009, 53(7): 597-9. doi：10.1016/j.jacc.2008.11.012
[19]	Penev Y, Ruppert MM, Bilgili A, et al. Intraoperative hypotension and postoperative acute kidney injury: a systematic review[J]. Am J Surg, 2024, 232: 45-53. doi：10.1016/j.amjsurg.2024.02.001
[20]	Mizota T, Yamamoto Y, Hamada M, et al. Intraoperative oliguria predicts acute kidney injury after major abdominal surgery[J]. Br J Anaesth, 2017, 119(6): 1127-34. doi：10.1093/bja/aex255
[21]	Zhu T. Hemodynamic influences of remimazolam versus propofol during the induction period of general anesthesia: a systematic review and meta-analysis of randomized controlled trials[J]. Pain Physician J, 2023, 26(7): E761-73. doi：10.36076/ppj.2023.26.e761
[22]	Kopitkó C, Gondos T, Fülöp T, et al. Reinterpreting renal hemodynamics: the importance of venous congestion and effective organ perfusion in acute kidney injury[J]. Am J Med Sci, 2020, 359(4): 193-205. doi：10.1016/j.amjms.2020.01.012
[23]	Chen JH. Central venous pressure-guided fluid management in hepatectomy under remimazolam: Impact on postoperative renal and gastrointestinal recovery[J]. J Gastrointest Surg, 2025, 29(10): 102197. doi：10.1016/j.gassur.2025.102197
[24]	Zhang F, Hu JS, Zhang KY, et al. Perioperative, functional, and oncologic outcomes of laparoscopic partial nephrectomy versus open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis[J]. Front Oncol, 2024, 13: 1283935. doi：10.3389/fonc.2023.1283935
[25]	Li SY, Guo ZL, Li Y, et al. The impact of warm ischemia time on short-term renal function after partial nephrectomy: a systematic review and meta-analysis[J]. BMC Urol, 2025, 25(1): 121. doi：10.1186/s12894-025-01803-w
[26]	de Jong BT, Eleveld DJ, Mason KP, et al. Clinical pharmacokinetics and pharmacodynamics of remimazolam[J]. Clin Pharmacokinet, 2025, 64(9): 1263-82. doi：10.1007/s40262-025-01548-7
[27]	Yaşar E, Toker MK, Saruhan E, et al. Impact of liberal versus restrictive fluid management on acute kidney ınjury after nephrectomy: a randomised controlled trial with cystatin C evaluation[J]. BMC Urol, 2025, 25(1): 270. doi：10.1186/s12894-025-01954-w
[28]	Francoz C, Glotz D, Moreau R, et al. The evaluation of renal function and disease in patients with cirrhosis[J]. J Hepatol, 2010, 52(4): 605-13. doi：10.1016/j.jhep.2009.11.025
[29]	Xu X, Nie S, Xu H, et al. Detecting neonatal AKI by serum cystatin C[J]. J Am Soc Nephrol, 2023, 34(7): 1253-63. doi：10.1681/asn.0000000000000125
[30]	Stöhr T, Colin PJ, Ossig J, et al. Pharmacokinetic properties of remimazolam in subjects with hepatic or renal impairment[J]. Br J Anaesth, 2021, 127(3): 415-23. doi：10.1016/j.bja.2021.05.027
[31]	den Bakker E, Musters M, Hubeek I, et al. Concordance between creatinine- and cystatin C-based eGFR in clinical practice[J]. Scand J Clin Lab Investig, 2021, 81(2): 142-6. doi：10.1080/00365513.2021.1871776
[32]	Lees JS, Fabian JN, Shlipak MG. Cystatin C should be routinely available for estimating kidney function[J]. Curr Opin Nephrol Hypertens, 2024, 33(3): 337-43. doi：10.1097/mnh.0000000000000980
[33]	Mathew GG. The utility of eGFR difference (eGFRCystatin C-eGFRCreatinine) in the diagnosis, prognosis, and management of chronic kidney disease: a comprehensive review[J]. Ir J Med Sci 1971, 2026, 195(1): 511-20. doi：10.1007/s11845-025-04221-x
[34]	Spencer S, Desborough R, Bhandari S. Should cystatin C eGFR become routine clinical practice[J]? Biomolecules, 2023, 13(7): 1075. doi：10.3390/biom13071075
[35]	Potok OA, Ix JH, Shlipak MG, et al. The difference between cystatin C- and creatinine-based estimated GFR and associations with frailty and adverse outcomes: a cohort analysis of the systolic blood pressure intervention trial (SPRINT)[J]. Am J Kidney Dis, 2020, 76(6): 765-74. doi：10.1053/j.ajkd.2020.05.017
[36]	Niculae A, Gherghina ME, Peride I, et al. Pathway from acute kidney injury to chronic kidney disease: molecules involved in renal fibrosis[J]. Int J Mol Sci, 2023, 24(18): 14019. doi：10.3390/ijms241814019
[37]	Wang ZW, Zhang C. From AKI to CKD: maladaptive repair and the underlying mechanisms[J]. Int J Mol Sci, 2022, 23(18): 10880. doi：10.3390/ijms231810880
[38]	Abdala PM, Swanson EA, Hutchens MP. Meta-analysis of AKI to CKD transition in perioperative patients[J]. Perioper Med, 2021, 10(1): 24. doi：10.1186/s13741-021-00192-6
[39]	Zhang TF, Widdop RE, Ricardo SD. Transition from acute kidney injury to chronic kidney disease: mechanisms, models, and biomarkers[J]. Am J Physiol Ren Physiol, 2024, 327(5): F788-805. doi：10.1152/ajprenal.00184.2024

Variable	Before PSM				After PSM
Variable	Control group (n=184)	Remimazolam group (n=81)	t/x²/z	P	Control group (n=65)	Remimazolam group (n=65)	t/x²/z	P
Age (year, Mean±SD)	52±14	54±12	-1.148	0.252	53±15	54±11	-0.448	0.655
Male/Female (n)	122/62	53/28	0.019	0.890	46/19	46/19	0.000	1.000
BMI (kg/m², Mean±SD)	25.42±12.37	25.58±11.47	-0.348	0.728	25.61±4.15	25.83±3.22	-0.335	0.738
ASA [n (%)]			1.208	0.751			1.592	0.661
Ⅰ	40 (21.7)	14 (17.3)			11 (16.9)	12 (18.5)
Ⅱ	133 (72.3)	63 (77.8)			48 (73.8)	49 (75.4)
Ⅲ	11 (6.0)	4 (4.9)			6 (9.2)	4 (6.2)
Combined disease [n (%)]
Diabetes	25 (13.6)	12 (14.8)	0.071	0.79	9 (13.8)	11 (16.9)	0.236	0.627
Hypertension	70 (38.0)	25 (30.9)	1.260	0.262	25 (38.5)	24 (36.9)	0.033	0.856
Cardiovascular disease	23 (12.5)	12 (14.8)	0.263	0.608	11 (16.9)	12 (18.5)	0.053	0.818
Operation time [min, M (P₂₅, P₇₅)]	126.50 (105.50, 148.00)	130.00 (110.00, 170.00)	1.975	0.048	135.0 (110.0, 157.5)	130.0 (110.0, 162.50)	-0.021	0.983
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	23.00 (16.25, 28.00)	21.00 (17.00, 27.00)	-0.602	0.547	22.0 (15.0, 28.0)	23.0 (17.50, 27.0)	0.545	0.585
Preoperative sCr [μmol/L, M (P₂₅, P₇₅)]	67.0 (56.0, 77.0)	68.0 (55.0, 77.5)	-0.064	0.949	69.00 (60.50, 76.50)	69.00 (55.50, 76.50)	-0.431	0.667
Preoperative β₂-MG [mg/L, M (P₂₅, P₇₅)]	1.61 (1.38, 1.92)	2.03 (1.85, 2.29)	6.896	<0.01	2.03 (1.69, 2.37)	2.01 (1.86, 2.23)	0.123	0.902
Preoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.77 (0.68, 0.88)	0.84 (0.84, 0.90)	4.926	<0.01	0.84 (0.80, 0.97)	0.84 (0.84, 0.90)	-0.060	0.956
Preoperative CRP [mg/L, M (P₂₅, P₇₅)]	1.49 (0.66, 4.56)	1.50 (0.72, 5.80)	0.474	0.635	1.48 (0.52, 5.93)	1.62 (0.69, 5.30)	-0.228	0.820
Preoperative eGFRsCr [mL/(min·1.73 m²), Mean±SD]	91.47±16.60	91.00±16.44	0.216	0.829	89.69±18.48	91.59±16.76	-0.614	0.540
Preoperative eGFRCys-C [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	109.25 (96.58, 119.25)	103.16 (90.79, 109.56)	-3.957	<0.01	101.93 (82.65, 112.99)	103.99 (91.63, 108.24)	0.102	0.918
Preoperative eGFRdiff [mL/(min·1.73 m²), Mean±SD]	14.51±16.98	7.59±16.62	3.075	0.002	6.94±15.46	7.81±13.71	-0.339	0.735

Variable	Before PSM				After PSM
Variable	Control group (n=184)	Remimazolam group (n=81)	t/x²/z	P	Control group (n=65)	Remimazolam group (n=65)	t/x²/z	P
Age (year, Mean±SD)	52±14	54±12	-1.148	0.252	53±15	54±11	-0.448	0.655
Male/Female (n)	122/62	53/28	0.019	0.890	46/19	46/19	0.000	1.000
BMI (kg/m², Mean±SD)	25.42±12.37	25.58±11.47	-0.348	0.728	25.61±4.15	25.83±3.22	-0.335	0.738
ASA [n (%)]			1.208	0.751			1.592	0.661
Ⅰ	40 (21.7)	14 (17.3)			11 (16.9)	12 (18.5)
Ⅱ	133 (72.3)	63 (77.8)			48 (73.8)	49 (75.4)
Ⅲ	11 (6.0)	4 (4.9)			6 (9.2)	4 (6.2)
Combined disease [n (%)]
Diabetes	25 (13.6)	12 (14.8)	0.071	0.79	9 (13.8)	11 (16.9)	0.236	0.627
Hypertension	70 (38.0)	25 (30.9)	1.260	0.262	25 (38.5)	24 (36.9)	0.033	0.856
Cardiovascular disease	23 (12.5)	12 (14.8)	0.263	0.608	11 (16.9)	12 (18.5)	0.053	0.818
Operation time [min, M (P₂₅, P₇₅)]	126.50 (105.50, 148.00)	130.00 (110.00, 170.00)	1.975	0.048	135.0 (110.0, 157.5)	130.0 (110.0, 162.50)	-0.021	0.983
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	23.00 (16.25, 28.00)	21.00 (17.00, 27.00)	-0.602	0.547	22.0 (15.0, 28.0)	23.0 (17.50, 27.0)	0.545	0.585
Preoperative sCr [μmol/L, M (P₂₅, P₇₅)]	67.0 (56.0, 77.0)	68.0 (55.0, 77.5)	-0.064	0.949	69.00 (60.50, 76.50)	69.00 (55.50, 76.50)	-0.431	0.667
Preoperative β₂-MG [mg/L, M (P₂₅, P₇₅)]	1.61 (1.38, 1.92)	2.03 (1.85, 2.29)	6.896	<0.01	2.03 (1.69, 2.37)	2.01 (1.86, 2.23)	0.123	0.902
Preoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.77 (0.68, 0.88)	0.84 (0.84, 0.90)	4.926	<0.01	0.84 (0.80, 0.97)	0.84 (0.84, 0.90)	-0.060	0.956
Preoperative CRP [mg/L, M (P₂₅, P₇₅)]	1.49 (0.66, 4.56)	1.50 (0.72, 5.80)	0.474	0.635	1.48 (0.52, 5.93)	1.62 (0.69, 5.30)	-0.228	0.820
Preoperative eGFRsCr [mL/(min·1.73 m²), Mean±SD]	91.47±16.60	91.00±16.44	0.216	0.829	89.69±18.48	91.59±16.76	-0.614	0.540
Preoperative eGFRCys-C [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	109.25 (96.58, 119.25)	103.16 (90.79, 109.56)	-3.957	<0.01	101.93 (82.65, 112.99)	103.99 (91.63, 108.24)	0.102	0.918
Preoperative eGFRdiff [mL/(min·1.73 m²), Mean±SD]	14.51±16.98	7.59±16.62	3.075	0.002	6.94±15.46	7.81±13.71	-0.339	0.735

Variable	SMD before PSM	SMD after PSM	Balance status (After PSM)
Age	0.144	0.079	Good (<0.1)
Male/Female	0.018	0	Good (<0.1)
BMI	0.046	0.059	Good (<0.1)
ASA	0.07	0.093	Good (<0.1)
Combined disease
Diabetes	0.035	0.085	Good (<0.1)
Hypertension	0.15	0.032	Good (<0.1)
Cardiovascular disease	0.068	0.04	Good (<0.1)
Operation time	0.363	0.03	Good (<0.1)
Renal artery occlusion time	0.084	0.014	Good (<0.1)
Preoperative sCr	0.062	0.187	Acceptable (0.1~0.2)
Preoperative β₂-MG	0.817	0.082	Good (<0.1)
Preoperative Cys-C	0.458	0.202	Acceptable (0.1~0.2)
Preoperative CRP	0.098	0.114	Acceptable (0.1~0.2)

Variable	SMD before PSM	SMD after PSM	Balance status (After PSM)
Age	0.144	0.079	Good (<0.1)
Male/Female	0.018	0	Good (<0.1)
BMI	0.046	0.059	Good (<0.1)
ASA	0.07	0.093	Good (<0.1)
Combined disease
Diabetes	0.035	0.085	Good (<0.1)
Hypertension	0.15	0.032	Good (<0.1)
Cardiovascular disease	0.068	0.04	Good (<0.1)
Operation time	0.363	0.03	Good (<0.1)
Renal artery occlusion time	0.084	0.014	Good (<0.1)
Preoperative sCr	0.062	0.187	Acceptable (0.1~0.2)
Preoperative β₂-MG	0.817	0.082	Good (<0.1)
Preoperative Cys-C	0.458	0.202	Acceptable (0.1~0.2)
Preoperative CRP	0.098	0.114	Acceptable (0.1~0.2)

Group	∆MAP (mmHg)			∆HR (beat/min)
Group	∆MAP₁	∆MAP₂	∆MAP₃	∆HR₁	∆HR₂	∆HR₃
Control	-4.62±8.75	-9.38±12.97	-20.11±11.65	-2.09±9.50	-3.78±11.18	-10.85±15.54
Remimazolam	-2.71±6.72	-7.15±12.07	-13.54±12.75	0.63±6.00	2.82±10.79	-3.35±11.67
t	-1.395	-1.015	-3.067	-1.954	-3.426	-3.108
P	0.165	0.312	0.003	0.053	0.001	0.002
Corrected P-value	0.990	1.000	0.018	0.318	0.006	0.012

瑞马唑仑稳定诱导期血流动力学但未降低腹腔镜肾部分切除术后肾损伤风险：一项倾向性评分匹配的回顾性队列研究

Remimazolam stabilizes hemodynamics during anesthesia induction but fails to reduce renal injury risk following laparoscopic partial nephrectomy: a propensity score-matched retrospective cohort study

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Variable	Control group	Remimazolam group	P
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	22.0 (15.0, 28.0)	23.0 (17.5, 27.0)	0.585
Operation time [min, M (P₂₅, P₇₅)]	135 (110, 158)	130 (110, 163)	0.983
Blood loss [mL, M (P₂₅, P₇₅)]	100 (50, 100)	100 (100, 100)	0.565
Urine output [mL, M (P₂₅, P₇₅)]	100 (100, 250)	100 (100, 200)	0.082
Crystalloid fluid intake[mL, M (P₂₅, P₇₅)]	1500 (1000, 1500)	1000 (1000, 1500)	0.065
Colloid fluid intake [mL, M (P₂₅, P₇₅)]	0 (0, 500)	0 (0, 500)	0.482
Postoperative sCr [μmol/L, M (P₂₅, P₇₅)]	85.0 (70.0, 101.5)	84.0 (70.5, 103.5)	0.927
Postoperative β2-MG [mg/L, M (P₂₅, P₇₅)]	1.94 (1.62, 2.25)	2.07 (2.03, 2.17)	0.467
Postoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.91 (0.77, 1.01)	0.96 (0.96, 1.03)	0.001
postoperative eGFRsCr [mL/(min·1.73 m²), Mean±SD]	76.29±19.49	75.13±18.96	0.734
postoperative eGFRCys-C [mL/(min·1.73 m²), Mean±SD]	94.83±20.92	83.65±9.84	<0.01
postoperative eGFRdiff [mL/(min·1.73 m²), Mean±SD]	18.55±17.06	8.52±15.85	0.001
Postoperative CRP [mg/L, M (P₂₅, P₇₅)]	27.40 (13.03, 41.44)	31.58 (16.97, 51.70)	0.397
Postoperative AKI [n (%)]	17 (26.2)	20 (30.8)	0.560

Age (year)	Control group		Remimazolam group(n=65)		P
Age (year)	n	AKI [n (%)]	n	AKI [n (%)]	P
18-44	21	3 (14.29)	14	3 (21.43)	0.583
45-64	25	6 (24.00)	39	14 (35.90)	0.316
≥65	19	8 (42.11)	12	3 (25.00)	0.332

Variable	Follow-up group group (n=77)	Lost to follow-up group group (n=53)	t/x²/z	P
Age (year, Mean±SD)	55±13	52±13	-1.192	0.235
Male/Female (n)	60/17	32/21	4.671	0.031
BMI (kg/m², Mean±SD)	25.99±3.51	25.33±3.97	-1.001	0.319
ASA [n (%)]			4.216	0.239
Ⅰ	11 (14.28)	12 (22.64)
Ⅱ	58 (75.32)	39 (73.58)
Ⅲ	8 (10.39)	2 (3.8)
Combined disease [n (%)]
Diabetes	10 (12.99)	10	0.834	0.361
Hypertension	33 (42.86)	16 (30.19)	2.145	0.143
Cardiovascular disease	16 (20.78)	7 (13.21)	1.236	0.266
Operation time [min, M (P₂₅, P₇₅)]	125 (105, 155)	140 (120, 175)	-2.777	0.005
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	22.0 (15.5, 27.0)	23.0 (17.0, 29.5)	-0.837	0.402
Preoperative sCr [μmol/L, M (P₂₅, P₇₅)]	72.0 (65.0, 78.5)	66.0 (54.0, 71.0)	3.477	0.001
Preoperative β₂-MG [mg/L, M (P₂₅, P₇₅)]	2.04 (1.78, 2.38)	2.01 (1.70, 2.20)	1.144	0.253
Preoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.84 (0.84, 1.02)	0.84 (0.82, 0.89)	2.037	0.042
Preoperative CRP [mg/L, M (P₂₅, P₇₅)]	1.48 (0.58, 5.36)	1.62 (0.61, 6.04)	-0.190	0.850
Preoperative eGFRsCr [mL/(min·1.73 m²), Mean±SD]	95.50±16.90	102.69±10.51	2.984	0.003

Variable	Control group (n=36 )	Remimazolam group (n=41 )	P
Age (year, Mean±SD)	55±16	55±11	0.767
Male/Female (n)	28/8	32/9	0.977
BMI (kg/m², Mean±SD)	25.49±3.93	26.43±3.07	0.241
Operation time [min, M (P₂₅, P₇₅)]	123 (105, 145)	125 (105, 158)	0.556
Renal artery occlusion time [min, M (P₂₅, P₇₅)]	19 (15, 25)	25 (20, 28)	0.035
Crystalloid fluid intake [mL, M (P₂₅, P₇₅)]	1500 (1000, 1500)	1000 (1000, 1500)	0.083
Colloid fluid intake [mL, M (P₂₅, P₇₅)]	0 (0, 500)	0 (0, 500)	0.193
Preoperative sCr [μmol/L, M (P₂₅, P₇₅)]	72.00 (64.25, 83.50)	72.00 (65.50, 78.00)	0.728
Preoperative β2-MG [mg/L, M (P₂₅, P₇₅)]	2.05 (1.70, 2.50)	2.04 (1.87, 2.35)	0.955
Preoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.85 (0.79, 1.07)	0.84 (0.84, 0.95)	0.627
Preoperative eGFRsCr [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	89.59 (76.40, 101.61)	95.85 (78.20, 107.50)	0.300
Preoperative eGFRCys-C [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	100.7 (71.50, 114.30)	103.16 (88.22, 107.81)	0.818
Preoperative eGFRdiff [mL/(min·1.73 m²), M (P₂₅, P₇₅)]	4.77 (-5.60, 16.60)	2.85 (-4.69, 12.39)	0.642
Preoperative CRP [mg/L, M (P₂₅, P₇₅)]	1.53 (0.49, 4.66)	1.31 (0.69, 6.04)	0.890
Postoperative sCr [μmol/L, M (P₂₅, P₇₅)]	96.50 (72.75, 113.25)	90.00 (81.50, 116.50)	0.732
Postoperative β2-MG [mg/L, M (P₂₅, P₇₅)]	2.07 (1.52, 2.55)	2.07 (2.07, 2.33)	0.148
Postoperative Cys-C [mg/L, M (P₂₅, P₇₅)]	0.955 (0.763, 1.068)	0.960 (0.960, 1.065)	0.008
Postoperative eGFRsCr[mL/ (min·1.73 m²), M (P₂₅, P₇₅)] (3 months to 1 year postoperatively)	81.40 (54.93, 106.13)	84.20 (59.25, 100.00)	0.992
Postoperative eGFRsCr[mL/ (min·1.73 m²), M (P₂₅, P₇₅)] (24 hours postoperatively)	71.75 (56.70, 81.29)	72.29 (53.73, 86.02)	0.951
Postoperative eGFRCys-C [mL/(min·1.73 m²), M (P₂₅, P₇₅)] (24 hours postoperatively)	94.84 (72.70, 112.27)	83.81 (75.51, 89.29)	0.013
Postoperative eGFRdiff [mL/(min·1.73 m²), M (P₂₅, P₇₅)] (24 hours postoperatively)	20.61 (10.30, 34.96)	6.95 (-3.80, 21.55)	0.020
Postoperative CRP [mg/L, M (P₂₅, P₇₅)]	25.05 (14.24, 39.34)	30.89 (15.77, 52.58)	0.491
Postoperative AKI [n (% )]	14 (38.89)	17 (41.46)	0.818
CKD [n (% )]	14 (38.89)	11 (26.83)	0.259

Postoperative AKI	CKD		χ²	r	P
Postoperative AKI	No	Yes	χ²	r	P
No	39 (75.0)	7 (28.0)	15.506	0.449	<0.01
Yes	13 (25.0)	18 (72.0)	15.506	0.449	<0.01

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Group	∆MAP (mmHg)			∆HR (beat/min)
Group	∆MAP₁	∆MAP₂	∆MAP₃	∆HR₁	∆HR₂	∆HR₃
Control group (n=36 )	-5.11±7.82	-11.64±12.33	-20.56±12.00	-2.75±7.17	-2.81±11.76	-10.28±16.45
Remimazolam group (n=41 )	-3.37±7.19	-8.49±13.29	-15.12±13.74	0.78±6.98	2.61±11.01	-4.24±11.36
t	-1.020	-1.073	-1.836	-2.187	-2.086	-1.892
P	0.340	0.163	0.453	0.785	0.815	0.061
Corrected P-value	1.000	0.978	1.000	1.000	1.000	0.366

Group	∆MAP (mmHg)			∆HR (beat/min)
Group	∆MAP₁	∆MAP₂	∆MAP₃	∆HR₁	∆HR₂	∆HR₃
Control group (n=36 )	-5.11±7.82	-11.64±12.33	-20.56±12.00	-2.75±7.17	-2.81±11.76	-10.28±16.45
Remimazolam group (n=41 )	-3.37±7.19	-8.49±13.29	-15.12±13.74	0.78±6.98	2.61±11.01	-4.24±11.36
t	-1.020	-1.073	-1.836	-2.187	-2.086	-1.892
P	0.340	0.163	0.453	0.785	0.815	0.061
Corrected P-value	1.000	0.978	1.000	1.000	1.000	0.366