不同剂量瑞马唑仑对老年骨科手术患者镇静效果及术后认知功能的影响  

Effects of different doses of remazolam on sedation effect and postoperative cognitive function in elderly orthopedic surgery patients

作　　者：李加鹏 王伟[1] 石军 LI Jia-peng;WANG Wei;SHI Jun(Department of Anesthesiology,Huainan First People's Hospital,the First Affiliated Hospital of Anhui University of Science&Technology,Huainan 232007,Anhui,China)

机构地区：[1]安徽理工大学第一附属医院·淮南市第一人民医院麻醉科,安徽淮南232007

出　　处：《川北医学院学报》2023年第9期1236-1240,共5页Journal of North Sichuan Medical College

基　　金：安徽省淮南市指导性科技计划项目(116)。

摘　　要：目的:探讨不同剂量瑞马唑仑对老年骨科手术患者镇静效果术后发生认知功能的影响。方法:选取104例老年骨科手术患者为研究对象,根据麻醉剂瑞马唑仑使用剂量不同分为高剂量组(0.3 mg/kg)及低剂量组(0.2 mg/kg),每组各52例。比较两组患者麻醉效果[镇痛持续时间、麻醉起效时间、感觉阻滞时间及苏醒时脑电双频指数(BIS)]、镇静效果(Ramsay评分)、血流动力学指标[平均动脉压(MAP)、心率(HR)及血氧饱和度(SaO2)]、应激指标[皮质醇(Cor)及去甲肾上腺素(NE)]及认知功能[简易精神状态检测表(MMSE)评分],分析影响患者发生认知障碍的相关因素。结果:高剂量组患者镇痛持续时间长于低剂量组,麻醉起效时间及感觉阻滞时间短于低剂量组,差异均有统计学意义(P<0.05);两组患者苏醒时BIS比较,差异无统计学意义(P>0.05)。高剂量组各时间点Ramsay评分均高于低剂量组(P<0.05)。麻醉后15 min,两组患者MAP、SaO2水平均降低(P<0.05),且高剂量组低于低剂量组(P<0.05);HR水平均升高(P<0.05),且高剂量组高于低剂量组(P<0.05)。低剂量组血清Cro及NE水平低于高剂量组;MMSE评分高于高剂量组(P<0.05)。回归分析显示,患者年龄较大、高剂量麻醉及麻醉15 min时HR水平较低均为影响患者发生认知障碍的相关因素。结论:低剂量与高剂量瑞马唑仑麻醉均具有较高麻醉及镇静效果,但低剂量麻醉后患者血流动力学变化相对平缓,且不易导致患者出现较大应激反应;年龄较大、高剂量麻醉及麻醉15 min时HR水平较低均可能提高患者术后发生认知障碍风险。Objective:To investigate the effect of different doses of remazolam on the sedation effect of elderly orthopedic surgery patients,and to analyze the relevant factors affecting the development of cognitive impairment after surgery.Methods:104 elderly orthopedic surgery patients were selected as the research subjects,and divided into high-dose group(0.3 mg/kg)and low-dose group(0.2 mg/kg)according to anesthesia dose selection,with 52 cases each group.The anesthesia effects[duration of pain relief,onset time of anesthesia,sensory block time,and bispectral index(BIS)at awakening],sedative effect(Ramsay score),hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SaO 2)],stress indicators[cortisol(Cor)and norepinephrine(NE)],and cognitive function[Mini Mental State Examination(MMSE)score]were compared between the two groups,and the factors affecting cognitive impairment were analyzed.Results:The duration of analgesia was longer in the high-dose group than that in the low-dose group,and the onset time of anesthesia and sensory block time were shorter than those in the low-dose group(P<0.05).There was no statistically significant difference in BIS between the two groups of patients when they woke up(P>0.05).The Ramsay score at all time points in the high-dose group was higher than that in the low-dose group(P<0.05).Compared with preoperative at 15 minutes after anesthesia,the levels of MAP and SaO 2 decreased(P<0.05),and the high-dose group was lower than the low-dose group(P<0.05).The levels of HR increased(P<0.05),and the high-dose group was higher than the low-dose group(P<0.05).The serum Cro and NE levels in the low-dose group were lower than those in the high-dose group,and the MMSE scores were higher than those in the high-dose group(P<0.05).Logistics regression analysis showed that older patients,high-dose anesthesia and low HR level during anesthesia for 15 minutes were all relevant factors affecting the development of cognitive impairment.Conclusion:Both low doses and hig

关 键 词：瑞马唑仑 老年 骨科手术 镇静效果 认知功能 影响因素 

分 类 号：R614[医药卫生—麻醉学]