瑞马唑仑对老年腹腔镜胆囊切除术患者血流动力学和术后认知功能的影响

Effect of Remimazolam on Hemodynamics and Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopic Cholecystectomy

目的探讨瑞马唑仑对老年腹腔镜胆囊切除术患者血流动力学和术后认知功能的影响。方法选取2021年1月至2022年12月在安阳市人民医院接受腹腔镜胆囊切除术的80例老年患者作为研究对象,按随机数字表法分为观察组和对照组,各40例,对照组麻醉诱导采用咪达唑仑,观察组麻醉诱导采用瑞马唑仑,其余麻醉诱导药物类型及剂量一致。于麻醉诱导前(T_(0))、气管插管时(T_(1))、切皮时(T_(2))和气管拔管时(T_(3))比较两组血流动力学。采用简易精神状态评价量表(MMSE)评价两组认知功能,记录两组患者术后苏醒时间、气管拔管时间以及麻醉监护室停留时间。结果两组患者T_(0)时HR和MAP等血流动力学差无统计学意义(P>0.05),T_(1)~T_(3)时间点,对照组HR和MAP均高于T_(0)时间点,且观察组患者两血流动力学指标低于对照组(P<0.05)。两组HR在各时间点与麻醉方式之间存在交互作用(P<0.05),而MAP不存在交互作用(P>0.05)。两组患者术前MMSE评分差异无统计学意义(P>0.05),患者术后24、48、72 h时,MMSE评分均较术前有降低,且观察组患者这3个时间点MMSE评分均高于对照组(P<0.05)。MMSE评分在各时间点与麻醉方式之间存在交互作用(P<0.05)。观察组患者术后苏醒时间、气管拔管时间以及麻醉监护室停留时间均低于对照组(P<0.05)。结论瑞马唑仑作为腹腔镜胆囊切除术的麻醉诱导剂,能够减轻老年患者术中血流动力学的异常波动,认知功能恢复较快,且术后麻醉恢复情况较优,可应用于老年患者全身麻醉的诱导。

Objective To explore the effects of remimazolam on hemodynamics and postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 80 elderly patients who underwent laparoscopic cholecystectomy in Anyang People’s Hospital from January 2021 to December 2022 were selected as the study objects,and were divided into observation group and control group by random number table method,with 40 cases in each group.The control group received midazolam for anesthesia induction,and the observation group received remimazolam for anesthesia induction.The types and doses of other anesthetic induction drugs were consistent between the two groups.The hemodynamics of the two groups were compared before anesthesia induction(T_(0)),during endotracheal intubation(T_(1)),skin resection(T_(2))and endotracheal extubation(T_(3)).Using the mini mental state evaluation scale(MMSE)to evaluate cognitive function in two groups.Record the postoperative recovery time,tracheal extubation time,and anesthesia monitoring room stay time of two groups of patients.Results There was no statistically difference in hemodynamics such as HR and MAP between the two groups of patients at T_(0)(P>0.05),while HR and MAP were higher in the control group at T_(1)-T_(3) compared to T_(0).HR and MAP in the observation group were lower than those in the control group at T_(1)-T_(3)(P<0.05).There was an interaction between two groups of HR and anesthesia method at different time points(P<0.05),while MAP did not have an interaction(P>0.05).There was no statistically difference in preoperative MMSE scores between the two groups of patients(P>0.05).At 24,48 and 72 hours postoperatively,MMSE scores decreased compared to preoperative levels,and the observation group had higher MMSE scores than the control group at these three time points(P<0.05).There was an interaction between MMSE scores and anesthesia methods at various time points(P<0.05).The postoperative recovery time,tracheal extubation time,and anesthesia monitoring room stay time of the observation group were all lower than those of the control group(P<0.05).Conclusion Remazolam,as an anesthetic inducer,can alleviate intraoperative hemodynamic fluctuations in elderly patients undergoing laparoscopic cholecystectomy,promote postoperative recovery of cognitive function and anesthesia effect,and can be applied to induce general anesthesia in elderly patients.