瑞马唑仑联合会阴区神经阻滞对老年患者认知功能和睡眠质量的影响  

Effects of remimazolam combined with perineal nerve block on cognitive function and sleep quality in elderly patients

作　　者：闫丽娟 王霄 YAN Lijuan;WANG Xiao(Department of Anesthesiology,the First Affiliated Hospital of Xiamen University,Xiamen FUJIAN 361003,China;Department of Ultrasound,the First Affiliated Hospital of Xiamen University,Xiamen FUJIAN 361003,China;School of Clinical Medicine,Fujian Medical University,Fuzhou FUJIAN 350122,China)

机构地区：[1]厦门大学附属第一医院麻醉科,福建厦门361003 [2]厦门大学附属第一医院超声科,福建厦门361003 [3]福建医科大学临床医学部,福建福州350122

出　　处：《中国新药与临床杂志》2023年第8期527-531,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：厦门市自然科学基金(3502Z20227345);福建中医药大学校管临床专项课题(XB2022184)。

摘　　要：目的分析瑞马唑仑联合会阴区神经阻滞对老年患者认知功能和睡眠质量的影响。方法选取拟行直肠超声引导下经会阴前列腺穿刺活检术的患者144例,随机分为2组,每组72例。干预组给予瑞马唑仑(负荷量3 mg·kg^(-1)·h^(-1)静脉泵注3 min,后以0.3 mg·kg^(-1)·h^(-1)维持)镇静下阴部神经和前列腺周围神经联合阻滞术,对照组给予全凭静脉麻醉(丙泊酚6 mg·kg^(-1)·h^(-1)复合瑞芬太尼5μg·kg^(-1)·h^(-1))。比较2组围术期的心率(HR)、平均动脉压(MAP)、疼痛视觉模拟量表(VAS)评分、术后认知功能、睡眠质量、离院时间和不良事件等情况。结果干预组超声探头置入时、穿刺活检时的HR和MAP显著高于对照组(P<0.05),而苏醒时的HR和MAP显著低于对照组(P<0.05)。与对照组比较,干预组术后当晚和第2晚的VAS评分显著降低(P<0.05),术后离院时间更早(P<0.05)。与麻醉前比较,干预组患者完全苏醒后的数字符号替换测试(DSST)评分和数字连接试验(NCT)评分均无显著差异(P>0.05),对照组苏醒后的DSST评分显著降低且显著低于干预组(P<0.05),苏醒后的NCT评分显著升高且显著高于干预组(P<0.05)。干预组术后3 d内的匹兹堡睡眠质量指数(PSQI)评分显著低于对照组(P<0.05)。干预组不良事件发生率显著低于对照组(8%vs.53%,P<0.05)。结论瑞马唑仑联合会阴区神经阻滞对经会阴前列腺穿刺老年患者认知功能和睡眠的影响较小,是一种安全且优效的麻醉方法。AIM To analyze the effects of remimazolam combined with perineal nerve block on cognitive function and sleep quality in elderly patients.METHODS A total of 144 patients(72 patients in each group)underwent transperineal prostate biopsy under the guidance of rectal ultrasound were randomly selected and divided into two groups.The intervention group received comprehensive perineal block technique of pudendal nerve and peripheral prostate nerve under sedation with remimazolam(a bolus of 3 mg·kg^(-1)·h^(-1)for 3 min and maintained with 0.3 mg·kg^(-1)·h^(-1)),while the control group received total intravenous anesthesia with propofol 6 mg·kg^(-1)·h^(-1)and remifentanil 5μg·kg^(-1)·h^(-1).The perioperative heart rate(HR),mean arterial pressure(MAP),visual analogue scale(VAS)score of pain,postoperative cognitive function,sleep quality,discharge time and adverse events were compared between two groups.RESULTS HR and MAP were significantly higher in the intervention group than those in the control group during ultrasound probe placement and puncture biopsy(P<0.05),while the HR and MAP of the intervention group were significantly lower than those of the control group during awakening(P<0.05).Compared with those in the control group,the VAS scores of the first and second night after surgery were significantly lower(P<0.05)and the patients were discharged earlier after the operation(P<0.05)in the intervention group.Compared with before anesthesia,there were no significant differences in the scores of digit symbol replacement test(DSST)and number connection test(NCT)after full recovery in the intervention group(P>0.05),the DSST score after full recovery in the control group was significantly decreased and significantly lower than that in the intervention group(P<0.05),and the NCT score after full recovery was significantly increased and significantly higher than that in the intervention group(P<0.05).The Pittsburgh sleep quality index(PSQI)scores of the intervention group within 3 days after surgery were significantly

关 键 词：瑞马唑仑 前列腺肿瘤 穿刺活检 认知功能障碍 睡眠 神经阻滞 

分 类 号：R971[医药卫生—药品]