瑞马唑仑麻醉对老年髋部骨折全麻手术患者术后谵妄的影响

Effect of remimazolam anesthesia on postoperative delirium in elderly patients with hip fractures undergoing general anesthesia surgery

目的分析瑞马唑仑与丙泊酚麻醉对老年髋部骨折全麻手术患者术后谵妄的影响。方法选取2021年8月至2023年8月于新乡市第二人民医院行髋部骨折全麻手术的80例老年患者,按入院顺序对患者进行编号并根据随机数字表法分为瑞马唑仑组(R组,n=40)和丙泊酚组(P组,n=40),R组予以0.2~0.4 mg/kg瑞马唑仑进行麻醉诱导及0.3~0.5 mg/(kg·h)瑞马唑仑进行麻醉维持,P组予以1.5~2 mg/kg丙泊酚进行麻醉诱导及4~8 mg/(kg·h)丙泊酚进行麻醉维持,比较两组围术期情况、术后谵妄发生情况、术后MMSE评分、血清炎性因子水平及围术期不良反应发生情况。结果R组血管活性药物剂量显著低于P组,差异有统计学意义(P<0.05);两组术后谵妄发生率、谵妄类型及谵妄持续时间比较差异均无统计学意义(P>0.05);两组术后1 d、3 d时的MMSE评分差异无统计学意义(P>0.05);R组术后24 h血清IL-6、CRP水平显著低于P组,差异有统计学意义(P<0.05);R组围术期低血压、注射痛发生率显著低于P组,差异有统计学意义(P<0.05),两组围术期恶心、呕吐、呼吸抑制及苏醒期躁动发生率差异无统计学意义(P>0.05)。结论与丙泊酚相比,瑞马唑仑在老年髋部骨折全麻手术中不会增加患者术后谵妄的可能性。

Objective To analyze the effect of remimazolam and propofol anesthesia on postoperative delirium in elderly patients with hip fractures undergoing general anesthesia surgery.Methods Totally 80 elderly patients who underwent general anesthesia surgery for hip fractures in the Second People's Hospital of Xinxiang from August 2021 to August 2023 were selected and numbered according to the admission sequence,and were randomly divided into remimazolam group(group R,n=40)and propofol group(group P,n=40)by using the random number table method.Group R was given 0.2-0.4mg/kg of remimazolam for anesthesia induction and 0.3-0.5 mg/(kg·h)of remimazolam for anesthesia maintenance,and group P was given 1.5-2mg/kg of propofol for anesthesia induction and 4-8 mg/(kg·h)of propofol for anesthesia maintenance.The perioperative status,occurrence of postoperative delirium,postoperative MMSE score,serum inflammatory factors levels and occurrence of perioperative adverse reactions were compared between both groups.Results The dosage of vasoactive drug in group R was significantly less than that in group P(P<0.05),but there were no statistically significant differences in the incidence rate,type and duration of postoperative delirium between the two groups(P>0.05).There was no statistical significance in MMSE score between the two groups at 1 day and 3 days after surgery(P>0.05).The levels of serum IL-6 and CRP in group R at 24 hours after surgery were significantly lower than those in group P(P<0.05).The incidence rates of perioperative hypotension and injection pain were significantly lower in group R than those in group P(P<0.05),but there was no significant difference in the incidence rates of perioperative nausea,vomiting,respiratory depression and agitation between the two groups(P>0.05).Conclusion Compared with propofol,remimazolam does not increase the risk of postoperative delirium in elderly patients undergoing general anesthesia surgery for hip fractures.