性别因素对瑞马唑仑用于老年患者全身麻醉苏醒期恢复质量的影响

Effect of gender on the quality of recovery during awakening in elderly patients undergoing general anesthesia with remimazolam

目的评价性别因素对瑞马唑仑用于老年患者全身麻醉苏醒质量的影响。方法选取2021年6月至2022年3月就诊于郑州大学第一附属医院,并拟择期行骨科手术老年患者106例,按性别分为男性组(M组,52例)和女性组(F组,54例)。记录两组患者手术及麻醉相关指标:手术时间、麻醉时间、瑞马唑仑总量、术前白蛋白浓度、出血量、输液量、尿量及血管活性药量;记录两组患者麻醉恢复相关指标:苏醒时间、拔管时间、麻醉后监测治疗室(PACU)总停留时间及拔管后改良Aldrete评分达9分时间;记录两组患者不良反应相关指标:诱导后5 min低血压、心动过缓及术中知晓、苏醒延迟、苏醒期躁动(Riker镇静-躁动评分≥5分)、PACU缺氧(SPO_(2)<90%)、术后恶心呕吐、头晕、乏力。计量资料采用t检验分析,计数资料采用χ^(2)检验分析。结果M组与F组患者苏醒时间及诱导后5 min低血压、心动过缓、苏醒期躁动、PACU缺氧发生率的比较差异无统计学意义[苏醒时间:(21.6±9.2)min比(22.6±10.4)min,t=-0.502;低血压:13.5%比20.4%,χ^(2)=-0.897;心动过缓:3.8%比7.4%,χ^(2)=0.628;苏醒期躁动:19.2%比11.1%,χ^(2)=1.363;PACU缺氧:7.7%比13.0%,χ^(2)=0.791,P>0.05]。两组患者中无一例发生术中知晓及苏醒延迟。M组拔管时间、PACU总停留时间及拔管后改良Aldrete评分达9分时间低于F组[(21.8±9.1)min比(26.4±13.7)min、(61.1±16.5)min比(73.4±29.4)min、(39.2±11.6)min比(46.9±22.5)min,t=-2.033、-2.670、-2.220,P<0.05]。M组术后恶心呕吐、头晕、乏力发生率低于F组[5.8%比22.2%、11.5%比27.8%、5.8%比20.4%,χ^(2)=5.903、4.397、4.927,P<0.05]。结论在接受瑞马唑仑全身麻醉的老年患者中,男性苏醒质量优于女性。

Objective To evaluate the effect of gender on the quality of recovery during awakening in older adults undergoing general anesthesia with remimazolam.Methods 106 older adults scheduled for elective orthopedic surgery in our hospital from June 2021 to March 2022 were divided into 2 groups according to gender:male group(group M,n=52)and female group(group F,n=54).Observation indicators related to surgery and anesthesia such as the operation time,anesthesia time,total remimazolam usage,preoperative concentration of albumin,blood loss,total fluid infusion,urine output and vasoactive drugs dose were recorded.Observation indicators related to anesthesia recovery such as recovery time,extubation time,total post-anesthesia care unit(PACU)stay time and the time required to reach a modified Aldrete score of 9 after extubation were recorded.Observation indicators related to adverse reactions such as post-induction hypotension,bradycardia,intraoperative awareness,delayed recovery,emergence agitation(Riker sedation-agitation score≥5),PACU hypoxia(SPO_(2)<90%),and postoperative dizziness,nausea,vomiting,fatigue were recorded.The measurement data were analyzed by t-test and the counting data byχ^(2)-test.Results There was no significant difference in the observation indicators related to surgery and anesthesia between the two groups(P>0.05).There was no significant difference in the recovery time and post-induction hypotension,bradycardia,emergence agitation,PACU hypoxia between the two groups[The recovery time:(21.6±9.2)min vs.(22.6±10.4)min,t=-0.502;Post-induction hypotension:13.5%vs.20.4%,χ^(2)=0.897;Bradycardia:3.8%vs.7.4%,χ^(2)=0.629;Emergence agitation:19.2%vs.11.1%,χ^(2)=1.363;PACU hypoxia:7.7%vs.13.0%,χ^(2)=0.791,P>0.05].The extubation time,the total PACU stay time and the time required to reach a modified Aldrete score of 9 in group M were significantly shorter than that in group F[(21.8±9.1)min vs.(26.4±13.7)min,(61.1±16.5)min vs.(73.4±29.4)min,(39.2±11.6)min vs.(46.9±22.5)min,t=-2.033,-2.670,-2.220,P<0.05].The incidence of postoperative dizziness,nausea,vomiting,fatigue in group M were significantly lower than that in group F[5.8%vs.22.2%,11.5%vs.27.8%,5.8%vs.20.4%,χ^(2)=5.903,4.397,4.927,P<0.05].No patient in the two groups experienced intraoperative awareness or delayed awakening.Conclusion Older men had better quality of recovery during awakening than older women undergoing general anesthesia with remimazolam.