瑞马唑仑与咪达唑仑对髋关节骨折围术期患者血流动力学及镇静的影响

Effects of remazolam and midazolam on hemodynamics and sedation in patients with hip fracture in perioperative period

目的探讨瑞马唑仑与咪达唑仑对髋关节骨折围术期患者血流动力学及镇静的影响。方法将112例择期行髋关节骨折手术患者随机分为观察组60例与对照组62例。2组患者术前均行腰硬联合麻醉,对照组静脉泵注0.05 mg/kg咪达唑仑镇静,后续以0.05 mg/(kg·h)的剂量不间断地泵注到脑电双频指数(BIS)降至75;观察组静脉注射0.3 mg/kg瑞马唑仑,并以5μg/(kg·min)的剂量不间断地泵注至BIS降至75。比较2组患者在阻滞平面稳定后(T0)、BIS下降到<75(T_(1))、手术开始30 min(T_(2))、停药时(T_(3))、停药后BIS上升到>90时(T_(4))的血氧饱和度(SpO_(2))、呼吸频率(RR)、心率(HR)、平均动脉压(MAP)水平及BIS。比较2组患者镇静起效时间、清醒时间及不良反应。结果观察组T_(2)时SpO_(2)、RR高于对照组,差异有统计学意义(P<0.05或P<0.01)。观察组T_(1)、T_(2)时HR较T0时升高,T_(3)、T_(4)时HR较T_(1)、T_(2)时降低,差异有统计学意义(P<0.05);对照组T_(1)~T_(4)的HR较T0时降低,差异有统计学意义(P<0.05);观察组T_(1)、T_(2)时HR高于对照组,差异有统计学意义(P<0.05)。观察组T_(1)~T_(4)的MAP较T0时降低,但差异无统计学意义(P>0.05);对照组T_(1)~T_(4)的MAP较T0下降,差异有统计学意义(P<0.05);观察组T_(1)、T_(2)的MAP高于对照组,差异有统计学意义(P<0.05)。2组T_(1)~T_(3)的BIS均较T0时降低,差异有统计学意义(P<0.05);观察组T_(1)~T_(2)的BIS低于对照组,差异有统计学意义(P<0.05)。观察组清醒时间、镇静起效时间分别为(6.71±2.72)、(1.81±0.92)min,短于对照组的(11.49±3.19)、(3.77±1.04)min,差异有统计学意义(P<0.05)。2组药物所致心动过缓、低血压、呼吸抑制等不良反应比较,差异无统计学意义(P>0.05)。结论髋关节骨折手术中可采用瑞马唑仑辅助镇静。与咪达唑仑相比,瑞马唑仑对血流动力学影响更小,镇静效果理想,恢复较快,不良反应较少。

Objective To explore the effects of remazolam and midazolam on hemodynamics and sedation in patients with hip fracture in perioperative period.Methods A total of 112 patients with selective hip fracture surgery were randomly divided into observation group(n=60)and control group(n=62).Patients in both group were conducted with combined spinal-epidural anesthesia before surgery,and the control group received intravenous infusion of 0.05 mg/kg midazolam for sedation,followed by continuous infusion of 0.05 mg/(kg·h)in purpose of reducing the bispectral index(BIS)to 75;the observation group received intravenous injection of 0.3 mg/kg remazolam,followed by continuous infusion of 5μg/(kg·min)in purpose of reducing the BIS to 75.At the time points of after stable block level(T 0),BIS decreasing to<75(T_(1)),30 minutes afterthe start of surgery(T_(2)),drug withdrawal(T_(3))and BIS increasing to>90 after drug withdrawal(T_(4)),the indexes such as oxygen saturation of blood(SpO_(2)),respiratory rate(RR),heart rate(HR),mean arterial pressure(MAP)and BIS were compared between the two groups.The onset time of sedation,awake time and adverse reactions were compared between the two groups.Results In the observation group,the SpO_(2) and RR at T_(2) were significantly higher than those in the control group(P<0.05 or P<0.01).HR at T_(1) and T_(2) in the observation group was significantly higher than that at T 0,while HR at T_(3) and T_(4) was significantly lower than that at T_(1) and T_(2)(P<0.05);HR at T_(1) to T_(4) in the control group was significantly lower than that at T 0(P<0.05);HR at T_(1) and T_(2) in the observation group was significantly higher than that in the control group(P<0.05).MAP at T_(1) to T_(4) in the observation group was lower than that at T 0(P>0.05);MAP at T_(1) to T_(4) in the control group was significantly lower than that at T 0(P<0.05);MAP at T_(1) and T_(2) in the observation group was significantly higher than that in the control group(P<0.05).BIS at T_(1) to T_(3) in both groups decreased significantly when compared to that at T 0(P<0.05);BIS at T_(1) and T_(2) in the observation group was significantly lower than that in the control group(P<0.05).The awake time and onset time of sedation in the observation group were(6.71±2.72)and(1.81±0.92)minutes respectively,which were significantly shorter than(11.49±3.19)and(3.77±1.04)minutes in the control group(P<0.05).There were no significant differences in adverse reactions such as bradycardia,hypotension and respiratory depression caused by the drugs between two groups(P>0.05).Conclusion In hip fracture surgery,remazolam can be used as an adjunct for sedation.Compared with midazolam,remazolam has advantages such as less impact on hemodynamics,ideal sedative effect,faster recovery and fewer adverse reactions.