瑞马唑仑对髋部骨折老年患者术后早期认知功能的影响  

Effects of remimazolam on early postoperative cognitive function in elderly patients with hip fracture

作　　者：段功宸 吴继敏 徐巧敏 江建鑫 蓝海燕 张旭彤[2] 袁开明[2] 李军[2] DUAN Gongchen;WU Jimin;XU Qiaomin;JIANG Jianxin;LAN Haiyan;ZHANG Xutong;YUAN Kaiming;LI Jun(Department of Anesthesiology,the Sixth Affiliated Hospital of Wenzhou Medical University,Lishui 323000,Zhejiang,China;Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang,China)

机构地区：[1]温州医科大学附属第六医院麻醉科,浙江丽水323000 [2]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,浙江温州325027

出　　处：《中国临床药理学与治疗学》2024年第2期146-153,共8页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省公益技术研究计划项目(LGF21H250004)。

摘　　要：目的:基于随机对照试验评估瑞马唑仑对髋部骨折老年患者术后早期认知功能的影响。方法:选取2022年12月至2023年6月间在温州医科大学附属第六医院腰硬联合麻醉下行髋部骨折手术并满足纳入标准的106名老年患者为研究对象,年龄65^90岁,ASA分级Ⅱ或Ⅲ级。按照随机数字表分为瑞马唑仑组(R组)、丙泊酚组(P组),每组53例。两组患者接受腰硬联合麻醉后,P组缓慢静注丙泊酚0.3^0.5 mg/kg(注射时间1 min)后以0.5^3 mg·kg^(-1)·h^(-1)泵注维持;R组缓慢静注瑞马唑仑负荷量0.05 mg/kg(注射时间1 min)后以0.1^0.3 mg·kg^(-1)·h^(-1)维持术中镇静。两组患者以维持改良警觉镇静评分(MOAA/S)为3^4分、脑电双频指数(BIS)值75^85间来调整泵注速率;缝合切口时停止输注镇静药。记录两组患者镇静前(T0),镇静后5(T1)、10(T2)、15(T3)、30(T4)、60min(T5)及术毕时(T6)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)、改良警觉镇静评分(MOAA/S)评分、BIS值,记录两组患者苏醒时间、术中遗忘、术后7 d内谵妄(POD)及神经认知恢复延迟(DNR)的发生率。结果:与T0时点比较,两组患者T1^T5时点的BIS和MOAA/S评分明显降低(P<0.05),T1^T6时点的MAP、HR显著降低(P<0.05)。与P组比较,R组患者T1^T6时点的MAP均更高(P均<0.05),苏醒时间短[(6.6±1.8)vs.(7.7±2.2)min,P<0.05],术后第7天Hopkins言语学习测试评分下降幅度更小(3.9±3.9 vs.6.2±4.6,P<0.05),术后谵妄、术后DNR发生率显著降低(7.5%vs. 28.3%,5.7%vs. 20.8%,P<0.05),术中遗忘发生率增高(52.8%vs. 28.3%,P<0.05);低血压、心动过缓发生率更低(15.1%vs. 37.7%,5.6%vs. 22.6%,P<0.05)、血管活性药物使用频次更少(P<0.05)。结论:瑞马唑仑用于髋部骨折老年患者可提供有效的围术期镇静,且血流动力学稳定,对术后早期神经认知功能影响小,总体安全性高于丙泊酚。AIM:To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial.METHODS:A total of 106 elderly patients,aged 65-90 years,ASA gradeⅡorⅢ,who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital ofWenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria,were selected and randomized into remimazolam group(group R)and propofol group(group P)according to the random number table,with 53 cases in each group.Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg/kg(injection time of 1min),followed by a pump infusion at 0.5-3 mg·kg^(-1)·h^(-1) for maintenance.In group R,intraoperative sedation was maintained by remimazolam at 0.1-0.3 mg·kg^(-1)·h^(-1) after a loading dose of 0.05 mg/kg(injection time of 1min).The pump infusion rate were adjusted by maintaining MOAA/S score at 3-4 and BIS value at 75-85,and stopped administering sedatives while suturing the incision.MOAA/S score,MAP,HR,RR,SpO2 and BIS values were recorded before sedation(T0),5(T1),10(T2),15(T3),30(T4)and 60(T5)min after sedation and at the end of surgery.The emergence time,intraoperative amnesia,the incidence of postoperative delirium(POD)and delayed neurocognitive recovery(DNR)within 7 days after operation,and the occurrence of adverse events during perioperative observation were recorded.RESULTS:Compared with T0,the BIS and MOAA/S scores of the two groups at T1-T5 were significantly decreased,and the MAP and HR of the two groups at T1-T6 were significantly lower(P<0.05).Compared with group P,group R showed higher MAP at all time points from T1 to T6(all P<0.05),shorter emergence time(6.6±1.8 vs.7.7±2.2 min,P<0.05),less decline in Hopkins Verbal Learning Test scores on postoperative day 7(3.9±3.9 vs.6.2±4.6,P<0.05),lower incidence of postoperative delirium and DNR(7.5%vs.28.3%,5.7%vs.20.8%,P<0.05),higher incidence of intraoper

关 键 词：瑞马唑仑 老年患者 腰硬联合麻醉 镇静 神经认知功能 

分 类 号：R614[医药卫生—麻醉学]