瑞马唑仑联合改良腹横筋膜平面阻滞对老年宫颈癌患者术后谵妄的影响

Effect of remazolam combined with modified TAPB on postoperative delirium in elderly patients with cervical cancer

目的探讨瑞马唑仑联合改良腹横筋膜平面阻滞对老年宫颈癌患者术后谵妄的影响。方法选择2021年7月~2023年7月在武威市人民医院行宫颈癌根治术的老年宫颈癌患者70例,根据数字随机表法将其分为瑞马唑仑组(n=35)和对照组(n=35),对照组接受常规全麻诱导,静脉注射咪达唑仑+舒芬太尼+异丙酚+罗库溴铵,瑞马唑仑组接受静脉注射舒芬太尼+瑞马唑仑+罗库溴铵麻醉诱导,在麻醉诱导后进行改良腹横肌筋膜阻滞,记录并比较两组不同时间点一般生命体征、苏醒指标、术后谵妄发生情况以及不良反应。结果与对照组比较,瑞马唑仑组在术后5 d时谵妄发生例数较少(P<0.05),术后7 d与对照组比较差异无统计学意义,但在麻醉苏醒期睁眼时间、停药拔管时间及在麻醉后监测治疗室停留时间上与对照组比较有明显优势,且术中生命体征更平稳。结论老年宫颈癌手术患者采用瑞马唑仑麻醉诱导,患者术中生命体征更加平稳,联合腹横筋膜平面阻滞,患者术后苏醒更快,可有效减少术后谵妄发生情况,且具有较高的安全性。

Objective To investigate the effect of remazolam combined with modified transversus abdominis plane block(TAPB)on postoperative delirium in elderly patients with cervical cancer.Methods Seventy elderly cervical cancer patients who underwent radical cervical cancer surgery in People's Hospital of Wuwei City from July 2021 to July 2023 were selected and randomly divided into a remazoram group(n=35)and a control group(n=35)using a digital randomization table method.The control group received routine general anesthesia induction,intravenous injection of midazolam+sufentanil+propofol+rocuronium.The remazoram group received intravenous injection of sufentanil+remazoram+rocuronium anesthesia induction.After anesthesia induction,modified TAPB was performed.General vital signs at different time points,awakening indicators,the occurrence of postoperative delirium and adverse reactions were recorded and compared between the two groups.Results Compared with the control group,the incidence of delirium in the remazolam group was lower at 5 days after surgery(P<0.05),and there was no statistically significant difference between the control group and the remazolam group at 7 days after surgery.,but there was an obvious advantage in the time of eye opening、extubation and stay in the PACU during the recovery period of anesthesia of the remazolam group,and the vital signs were more stable during operation compared to the control group.Conclusion Anesthesia induction with remazolam in elderly patients with cervical cancer surgery has more stable intraoperative vital signs,combined with TAPB,the patient recover faster after surgery,the occurrence of postoperative delirium can be effectively reduced and with high safety.