瑞马唑仑联合气管插管全身麻醉在老年髋部骨折内固定术中的应用

Application of Remimazolam Combined with Tracheal Intubation General Anesthesia in Elderly Patients with Hip Fracture Internal Fixation

目的观察瑞马唑仑联合气管插管全身麻醉在老年髋部骨折内固定术中的应用效果。方法选择2020年3月-2022年5月在我院行髋部骨折内固定术治疗的68例患者为研究对象,将其随机分为对照组(34例)和观察组(34例),对照组给予丙泊酚联合依托咪酯麻醉,观察组静脉注射瑞马唑仑,比较两组麻醉效果,并记录患者入手术室前、麻醉完成后、手术开始后以及术毕时的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),统计患者围术期不良反应发生率,采用简易智力状态评定量表(MMSE)评估患者认知功能变化情况。结果两组插管前BIS值比较,差异无统计学意义(P>0.05);观察组诱导至BIS≤60时间短于对照组(P<0.05);观察组麻醉完成后、手术开始后及术毕时SpO2与对照组比较,差异无统计学意义(P>0.05);观察组麻醉完成后、手术开始后及术毕时HR低于对照组,手术开始后MAP低于对照组(P<0.05);观察组围术期不良反应发生率(8.82%)低于对照组(29.41%)(P<0.05);两组术后6 h瞬时记忆、定向力及短暂记忆等认知功能评分均下降,但观察组瞬时记忆、定向力及短暂记忆等认知功能评分高于对照组(P<0.05)。结论瑞马唑仑联合气管插管全身麻醉应用于老年髋部骨折内固定术中可减轻患者认知功能,维持生命体征稳定,安全性高,不良反应少,值得临床应用。

Objective To observe the application effect of remimazolam combined with tracheal intubation general anesthesia in elderly patients with hip fracture internal fixation.Methods A total of 68 patients who underwent hip fracture internal fixation in our hospital from March 2020 to May 2022 were selected as the research objects.They were randomly divided into control group(34 patients)and observation group(34 patients).The control group was given propofol combined with etomidate anesthesia,and the observation group was given intravenous injection of remimazolam.The anesthetic effects of the two groups were compared.The heart rate(HR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO2)of the patients before entering the operating room,after anesthesia,after operation and at the end of operation were recorded.The incidence of perioperative adverse reactions was counted.Mini-mental state examination(MMSE)was used to evaluate the changes of cognitive function in patients.Results There was no significant difference in BIS value between the two groups before intubation(P>0.05).The time from induction to BIS≤60 in the observation group was shorter than that in the control group(P<0.05).There was no significant difference in SpO2 after the completion of anesthesia,after the beginning of surgery and at the end of surgery between the observation group and the control group(P>0.05).The HR after anesthesia,after operation and at the end of operation of the observation group was lower than that of the control group,and the MAP after operation was lower than that of the control group(P<0.05).The incidence of perioperative adverse reactions in the observation group(8.82%)was lower than that in the control group(29.41%)(P<0.05).The scores of cognitive function such as instantaneous memory,directional force and transient memory in the two groups decreased at 6 h after operation,but the scores of cognitive function such as instantaneous memory,directional force and transient memory in the observation group were higher than those in the control group(P<0.05).Conclusion Remimazolam combined with tracheal intubation general anesthesia in elderly patients with hip fracture internal fixation can reduce cognitive function,maintain stable vital signs,with high safety and less adverse reactions,which is worthy of clinical application.