甲苯磺酸瑞马唑仑在老年腰椎减压手术患者中的应用分析

Application Analysis of Remimazolam Besilate in Elderly Patients Undergoing Lumbar Decompression Surgery

目的探讨甲苯磺酸瑞马唑仑用于老年腰椎减压手术患者全身麻醉过程中的镇静效果,评价其对患者术后认知功能的影响。方法选择90例老年腰椎减压手术患者,随机分为研究组和对照组,每组45例。研究组麻醉诱导和维持期分别使用甲苯磺酸瑞马唑仑0.4 mg·kg^(-1)和1.0 mg·(kg·h)^(-1);对照组分别使用丙泊酚2.0 mg·kg^(-1)和4.0 mg·(kg·h)^(-1)。两组麻醉诱导期均使用舒芬太尼0.2~0.5μg·kg^(-1),维持期使用瑞芬太尼0.05~0.10μg·(kg·min)^(-1)。在麻醉诱导前(T0)、意识消失时(T1)、插管后1 min(T2)、切皮即刻(T3)及拔管后即刻(T4)时间点,比较两组的血流动力学指标变化,包括心率(HR)、平均动脉压(MAP)等;比较两组麻醉苏醒指标(自主呼吸恢复时间、睁眼时间)及术前、术后1 d、术后3 d时的蒙特利尔认知评估量表(MoCA)评分;观察两组不良反应发生情况。结果研究组自主呼吸恢复时间及睁眼时间短于对照组(P<0.05)。研究组T1、T2、T3时MAP及HR高于对照组,血管活性药物使用率低于对照组(P<0.05)。研究组术后1 d、术后3 d认知功能评分高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论甲苯磺酸瑞马唑仑用于老年腰椎减压手术患者,可维持血流动力学稳定,减少血管活性药物用量,提高苏醒质量,患者认知功能受影响较小。

Objective To investigate the sedative effect of remimazolam besilate in elderly patients undergoing lumbar decompression surgery and its impact on postoperative cognitive function.Methods 90 elderly patients undergoing lumbar decompression surgery were randomly divided into research group and control group with 45 cases in each group.The research group was administered remimazolam besilate at 0.4 mg·kg^(-1)for induction and 1.0 mg·(kg·h)^(-1)for maintenance of anesthesia;the control group was given propofol at 2.0 mg·kg^(-1)and 4.0 mg·(kg·h)^(-1),respectively.Both groups were given sufentanil at 0.2~0.5μg·kg^(-1)during induction and remifentanil at 0.05~0.10μg·(kg·min)^(-1)during maintenance.Hemodynamic parameters including heart rate(HR)and mean arterial pressure(MAP)were compared between the two groups at time points of pre-induction(T0),loss of consciousness(T1),1 min after intubation(T2),skin incision(T3)and extubation(T4).Anesthetic recovery indicators including time to spontaneous respiration recovery and eye opening were recorded.Montreal Cognitive Assessment(MoCA)scores were compared before surgery and 1 day and 3 days after surgery.Adverse reactions were observed.Results Time to spontaneous respiration recovery and eye opening were shorter in the research group compared to the control group(P<0.05).MAP and HR at T1,T2 and T3 were higher in the research group than the control group,and vasoactive drug usage was lower in the research group(P<0.05).Postoperative day 1 and day 3 MoCA scores were higher in the research group than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Remimazolam besilate maintains stable hemodynamics,reduces vasoactive drug usage,improves recovery quality and has less impact on cognitive function in elderly patients undergoing lumbar decompression.