脑氧饱和度监测联合瑞马唑仑麻醉对老年关节置换术患者术后谵妄及血清水平的影响  

Effect of monitoring cerebral regional oxygen saturation combined with remidazolam anesthesia on postoperative delirium and serum S100β levels in elderly patients undergoing joint replacement surgery

作　　者：赵建华 李双江 李梅 刘秀坤 张璐[3] ZHAO Jian-hua;LI Shuang-jiang;LI Mei;LIU Xiu-kun;ZHANG Lu(Department of Anesthesiology,Peking University Third Hospital Qinhuangdao Hospital;Department of Anesthesiology,Qinhuangdao Haigang Hospital;Operating Room,Peking University Third Hospital Qinhuangdao Hospital,Qinhuangdao 066000,Hebei,China)

机构地区：[1]北京大学第三医院秦皇岛医院麻醉科 [2]秦皇岛市海港医院麻醉科 [3]北京大学第三医院秦皇岛医院手术室,河北秦皇岛066000

出　　处：《川北医学院学报》2023年第12期1680-1684,共5页Journal of North Sichuan Medical College

基　　金：河北省秦皇岛市科学技术研究与发展计划项目(202101A118)。

摘　　要：目的:探讨脑氧饱和度(rSO_(2))监测联合瑞马唑仑麻醉对老年关节置换术患者术后谵妄及血清中枢神经特异蛋白(S100β蛋白)水平的影响。方法:选取行关节置换术的112例老年患者为研究对象。根据治疗方式不同将患者分为对照组与观察组,每组各56例,对照组使用常规瑞马唑仑麻醉方案;观察组使用rSO_(2)+瑞马唑仑麻醉方案,两组患者麻醉诱导及维持阶段操作相同。比较两组术后谵妄(POD)发生情况[谵妄评分法中文修订版(CAM-CR)];不同时间点[术前(T0)、麻醉后5 min(T1)、手术开始后3 min(T2)、手术开始后30 min(T3)及手术结束即刻(T4)]、生命体征[平均动脉压(MAP)、心率(HR)及脑电双频指数(BIS)]水平变化;不同时间点(术前、术毕即刻、术后24 h及术后48 h)中枢神经特异蛋白(S100β)的变化及两组术中、术后情况[瑞玛唑仑用量、术后睁眼时间及麻醉后监测治疗室(PACU)停留时间]比较;记录并比较两组补救镇静及不良反应发生情况。结果:观察组术后7 d POD发生率低于对照组;POD发生时间晚于对照组;POD持续时间短于对照组(P<0.05)。与T0时比较,两组T1~T4的MPA、HR及BIS均降低(P<0.05);与对照组相比,观察组T1~T4时MAP均更高,BIS更低(P<0.05);两组TI~T4时HR差异无统计学意义(P>0.05)。术毕即刻、术后24 h及48 h,两组S100β蛋白水平均高于术前(P<0.05),术后S100β蛋白水平随时间推移下降,且观察组均低于对照组(P<0.05)。观察组瑞玛唑仑使用量少于对照组(P<0.05);观察组睁眼时间及PACU停留时间短于对照组(P<0.05)。两组补救镇静及不良反应发生率比较,差异无统计学意义(P>0.05)。结论:rSO_(2)监测联合瑞马唑仑麻醉能降低老年关节置换手术患者POD发生率及血清S100β蛋白水平,有效维持生命体征平稳,且不增加不良反应发生率。Objective:To explore the effect of monitoring cerebral regional oxygen saturation(rSO_(2))combined with remidazolam anesthesia on postoperative delirium and serum central nervous system specific protein(S100β)in elderly patients undergoing joint replacement surgery.Methods:112 elderly patients who underwent joint replacement surgery were selected as the study subjects.They were divided into control group and observation group according to differennt treatment methods,with 56 cases in each group.The control group received conventional remimazolam anesthesia regimen,and the observation group used rSO_(2)^(+)remimazolam anesthesia regimen,and the anesthesia induction and maintenance stages were the same in both groups.The incidence of postoperative delirium(POD)[Delirium Scoring Method Chinese Revised Version(CAM-CR)],changes in vital signs levels[changes in mean arterial pressure(MAP),heart rate(HR),and BIS]at different time points[preoperative(T0),5 minutes after anesthesia(T1),3 minutes after surgery(T2),30 minutes after surgery(T3),and immediately after surgery(T4)],changes of S100βin different time points[preoperative,immediate postoperative,postoperative 24 hours,and postoperative 48 hours],and comparison of intraoperative and postoperative conditions between the two groups[dosage of ramazolam,postoperative eye opening time,and post anesthesia monitoring treatment room(PACU)stay time]were compared between two groups,and the occurrence of remedial sedation and adverse reactions in both groups were recorded.Results:The incidence of POD in the observation group was lower than that in the control group at 7 days after operation,the occurrence time of POD in the observation group was later than that in the control group,and the duration was shorter than that in the control group(P<0.05).Compared to T0,the MPA,HR,and BIS of both T1~T4 groups decreased(P<0.05).Compared with the control group,the observation group had higher MAP and lower BIS at T1~T4(P<0.05),there was no significant difference in HR between the two

关 键 词：脑氧饱和度 瑞马唑仑 老年 关节置换 术后谵妄 中枢神经特异蛋白 

分 类 号：R614.2[医药卫生—麻醉学]