瑞马唑仑联合右美托咪定对高龄腰椎手术患者脑氧代谢及认知功能的影响

Effects of Remimazolam Combined with Dexmedetomidine on Cerebral Oxygen Metabolism and Cognitive Function in Elderly Patients Undergoing Lumbar Spine Surgery

【目的】探讨瑞马唑仑联合右美托咪定(Dex)对高龄腰椎手术患者脑氧代谢及认知功能的影响。【方法】126例高龄腰椎手术患者,随机分为瑞马唑仑组(A组)、Dex组(B组)和联合组(C组),每组42例。三组患者均采用全凭静脉麻醉,A组给予瑞马唑仑麻醉,B组给予Dex麻醉,C组使用瑞马唑仑和Dex联合麻醉。比较三组患者麻醉前(T_(0))、麻醉药注射10 min后(T_(1))、气管插管时(T_(2))、手术结束前15 min(T_(3))、手术结束时(T_(4))的血流动力学指标、脑氧代谢指标,以及T_(0)、术后24 h时(T_(5))、术后48 h时(T_(6))的认知功能。【结果】C组患者T_(1)、T_(2)时的心率(HR)低于A组、B组(P<0.05),C组患者T_(1)、T_(2)、T_(3)、T_(4)时的平均动脉压(MAP)低于A组、B组(P<0.05);C组患者T_(1)、T_(2)、T_(3)、T_(4)时的脑氧摄取率(CEO_(2))、脑动静脉血氧含量差(Da-jvO_(2))均低于A组、B组,颈内静脉球血氧饱和度(SjvO_(2))高于A组、B组(P<0.05)。C组患者T_(5)、T_(6)时的简易智力状态检查(MMSE量表)评分均高于A组、B组(P<0.05)。【结论】瑞马唑仑联合Dex麻醉应于高龄腰椎手术患者中,可有效维持血流动力学稳定性,提高脑氧代谢水平,并显著提升患者的认知功能,值得临床推广使用。

【Objective】To investigate the effects of remimazolam combined with dexmedetomidine(Dex)on cerebral oxygen metabolism and cognitive function in elderly patients undergoing lumbar spine surgery.【Methods】A total of 126 elderly patients undergoing lumbar spine surgery were randomly divided into three groups:the remimazolam group(Group A),the Dex group(Group B),and the combined group(Group C),with 42 patients in each group.All patients received total intravenous anesthesia.Group A received remimazolam,Group B received Dex,and Group C received a combination of remimazolam and Dex.Hemodynamic parameters,cerebral oxygen metabolism indicators,and cognitive function were compared at five time points:pre-anesthesia(T_(0)),10 minutes after drug injection(T_(1)),at tracheal intubation(T_(2)),15 minutes before the end of surgery(T_(3)),and at the end of surgery(T_(4)),as well as the cognitive function at T_(0),24 hours postoperatively(T_(5)),and 48 hours postoperatively(T_(6)).【Results】Patients in group C had a lower heart rate(HR)at T_(1)and T_(2)compared to groups A and B(P<0.05).The mean arterial pressure(MAP)in group C was lower than that in groups A and B from T_(1)、T_(2)、T_(3)、T_(4)(P<0.05).The cerebral oxygen extraction rate(CEO_(2))and the arteriovenous oxygen content difference(Da-jvO_(2))in group C were lower than those in groups A and B during T_(1)、T_(2)、T_(3)、T_(4),while the jugular venous bulb oxygen saturation(SjvO_(2))in group C was higher than that in groups A and B(P<0.05).The MMSE scores of patients in group C at T_(5)and T_(6)were significantly higher than those in groups A and B(P<0.05).【Conclusion】Remimazolam combined with Dex anesthesia effectively improves hemodynamic stability,enhances cerebral oxygen metabolism,and significantly improves cognitive function in elderly patients undergoing lumbar spine surgery,warranting clinical promotion.