瑞马唑仑对老年髋关节置换术后患者苏醒质量、炎症应激及术后谵妄的影响  

Effect of Remimazolam on the quality of recovery from anesthesia,inflammatory stress and postoperative delirium in elderly patients after hip replacement

作　　者：赵建华 王玲 李梅 刘秀坤 张璐[3] 李双江 ZHAO Jianhua;WANG Ling;LI Mei;LIU Xiukun;ZHANG Lu;LI Shuangjiang(Department of Anesthesiology,Qinhuangdao Hospital,Peking University Third Hospital,Qinhuangdao 066000,China;Nursing Department of Huainan Maternal and Child Health Hospital,Huainan 232000,China;Operation Room,Qinhuangdao Hospital,Peking University Third Hospital,Qinhuangdao 066000,China;Department of Anesthesiology,Qinhuangdao Haigang Hospital,Qinhuangdao 066000,China)

机构地区：[1]北京大学第三医院秦皇岛医院麻醉科,河北秦皇岛066000 [2]淮南市妇幼保健院护理部,安徽淮南232000 [3]北京大学第三医院秦皇岛医院手术室,河北秦皇岛066000 [4]秦皇岛海港医院麻醉科,河北秦皇岛066000

出　　处：《长春中医药大学学报》2024年第3期335-339,共5页Journal of Changchun University of Chinese Medicine

基　　金：国家重点研发计划项目(2021YFC2701303)。

摘　　要：目的探讨瑞马唑仑对老年髋关节置换术后患者苏醒质量、炎症应激及术后谵妄的影响。方法将2021年11月-2023年3月北京大学第三医院秦皇岛医院收治的94例老年髋关节置换术患者,依据随机数字表法分为A组和B组,各47例。A组给予咪达唑仑、舒芬太尼、罗库溴铵进行麻醉诱导;B组则予以瑞马唑仑、舒芬太尼、罗库溴铵进行麻醉诱导,均观察至患者出院。比较2组苏醒期Riker镇静-躁动评分表(RSAS)评分;不同时间点生命体征、认知功能,术前、术后72 h炎症应激;术后住院期间并发症发生情况。结果与A组苏醒期RSAS评分≥5分的患者占比42.55%比,B组的10.64%相对更低(P<0.05);与T0进行比较,T1~3心率(HR)、平均动脉压(MAP)均呈先降低后升高趋势,且B组高于A组(P<0.05);术后72 h,2组血清促肾上腺皮质激素(ACTH)、一氧化氮(NO)、C反应蛋白(CRP)、白细胞介素-1β(IL-1β)水平与术前比较均升高,且B组低于A组(P<0.05);与T4比较,T5、T3、T62组认知功能评分呈现出先降低后升高的趋势,且B组高于A组(P<0.05);术后住院期间,与A组比较,B组发生谵妄、低氧血症的患者占比相对更低(P<0.05)。结论瑞马唑仑能够有效提高老年髋关节置换术患者术后的苏醒质量,缓解患者的炎症应激反应,稳定患者的生命体征,可改善患者的认知功能,降低患者术后谵妄、低氧血症的发生率且具有良好的安全性。Objective To explore the effect of Remimazolam on the quality of recovery from anesthesia,inflammatory stress and postoperative delirium in elderly patients after hip replacement.Methods 94 elderly patients with hip replacement in Qinhuangdao Hospial of Peking University Third Hospital from November 2021 to March 2023 were divided into group A and group B according to random number table method,with 47 patients in each group.Group A was given Midazolam,Sufentanil and Rocuronium bromide for anesthesia induction,while the group B was given Remimazolam,Sufentanil and Rocuronium bromide for anesthesia induction.All patients were observed till they were discharged from hospital.The scores of Riker Sedation-Agitation Scale(RSAS)of recovery period,vital signs and cognitive function at different time points,inflammatory stress before operaion and 72 hours after operation,and incedence of complications during postoperative hospitalization were compared between two groups.Results Compared with 42.55%of patients with recovery RSAS score≥5 in group A,10.64%in group B was relatively lower(P<0.05).Compared with T0,the heart rate(HR)and mean arterial pressure(MAP)of patients in T1~T3 of both groups all decreased at first and then increased,and group B was higher than group A(P<0.05).At 72 hours after operation,the levels of serum adrenocorticotropic hormone(ACTH),nitric oxide(NO),C-reactive protein(CRP)and interleukin-1β(IL-1β)in two groups were higher than those before operation,and group B was lower than group A(P<0.05).Compared with T4,the cognitive function scores of T5,T3 and T6 in 2 groups all decreased first and then increased,and group B was higher than group A(P<0.05).During postoperative hospitalization,compared with group A,the proportion of patients with delirium and hypoxemia in group B was relatively lower(P<0.05).Conclusion Remimazolam can effectively improve the recovery quality of elderly patients after hip replacement,relieve the inflammatory stress reaction of patients,stabilize the vital signs of patient

关 键 词：髋关节置换术 老年 瑞马唑仑 苏醒质量 炎症 应激 谵妄 

分 类 号：R971[医药卫生—药品]