瑞马唑仑对鼻内镜手术老年患者术中脑氧饱和度及术后认知功能的影响  

Effects of remimazolam on intraoperative cerebral oxygen saturation and postoperative cognitive function in elderly patients with nasal endoscopic surgery

作　　者：陈琴琴 胡茜[2] 陈秋红[2] 刘博文 杨文明 张学康[2] CHEN Qin-qin;HU Qian;CHEN Qiu-hong;LIU Bo-wen;YANG Wen-ming;ZHANG Xue-kang(The Afiliated Stomatological Hospital of Nanchang University,the Key Laboratory of Oral Biomedicine of Jiangxi Province,Jiangxi Province Clinical Research Center for Oral Diseases,Nanchang JIANGXI 330006,China;The First Affiliated Hospital of Nanchang University,Nanchang JIANGXI 330006,China)

机构地区：[1]南昌大学附属口腔医院、江西省口腔生物医学重点实验室、江西省口腔疾病临床医学研究中心,江西南昌330006 [2]南昌大学第一附属医院,江西南昌330006

出　　处：《中国新药与临床杂志》2024年第2期143-148,共6页Chinese Journal of New Drugs and Clinical Remedies

基　　金：江西省卫生健康委科技计划项目(202210379)。

摘　　要：目的探讨瑞马唑仑对鼻内镜手术老年患者术中脑氧饱和度及术后认知功能的影响。方法选择拟行鼻内镜手术的老年患者60例,随机均分为2组。对照组给予丙泊酚2.0mg·kg^(-1)诱导,丙泊酚4~6mg·kg^(-1)·h^(-1)维持,试验组给予瑞马唑仑0.3mg·kg^(-1)诱导,瑞马唑仑0.2~0.3mg·kg^(-1)·h^(-1)维持,2组其他麻醉诱导和维持给药相同。采用硝酸甘油0.5~2.0g·kg^(-1)·min^(-1)静脉泵注,使平均动脉压(MAP)维持在50~65mmHg,手术结束后停止泵注。术中监测局部脑氧饱和度(rcSO_(2)),并在麻醉诱导前、拔管后和术后1h检测血清S100β和白细胞介素(IL)-6浓度。应用蒙特利尔认知评估量表(MoCA)评估患者认知功能,检测血流动力学指标,观察术后苏醒质量。结果术前1d、术后1d和7d,2组MoCA评分比较均无显著差异(P>0.05);且术后1d和7d,2组术后认知功能障碍(POCD)发生率比较无显著差异(P>0.05)。与对照组比较,试验组降压后的rcSO_(2)显著增高(P<0.05),且rcSO_(2)的最大降幅显著减小(P<0.05)。与对照组比较,试验组拔管即刻和术后1h的S100β血清浓度显著降低(P<0.05),拔管即刻的IL-6浓度也显著降低(P<0.05)。插管即刻试验组HR和MAP显著高于对照组(P<0.05),降压即刻和手术结束即刻试验组的脑电双频指数值显著高于对照组(P<0.05)。试验组诱导时间显著长于对照组(P<0.05),睁眼时间、拔管时间显著短于对照组(P<0.05)。2组术后1、3h疼痛和镇静评分比较无显著差异(P>0.05),且均未发生明显不良反应。结论瑞马唑仑可减少老年鼻内镜手术患者术中S100β及IL-6的产生,并在一定程度上改善脑氧饱和度,但对POCD的发生无明显影响。AIM To investigate the effects of remimazolam on intraoperative cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing nasal endoscopy.METHODS Sixty elderly patients proposed for nasal endoscopic surgery were selected and randomly divided equally into two groups.The control group was given propofol 2.0 mg·kg^(-1)for induction and propofol 4-6 mg·kg^(-1)·h^(-1)for maintenance,while the trial group was given remimazolam 0.3 mg·kg^(-1)for induction and remimazolam 0.2-0.3 mg·kg^(-1)·h^(-1)for maintenance,and other anesthetic induction and maintenance doses were the same for the two groups.Nitroglycerin 0.5-2.0 g·kg^(-1)·min^(-1)was pumped intravenously to maintain the mean arterial pressure(MAP)at 50-65 mm Hg,and the pumping was stopped at the end of the procedure.Regional cerebral oxygen saturation(rc SO_(2))was monitored intraoperatively,and serum S100 and interleukin(IL)-6 concentrations were measured before induction of anesthesia,after extubation,and 1 h after surgery.The cognitive function was assessed by Montreal Cognitive Assessment(Mo CA),the hemodynamic indicators were measured,and the quality of postoperative awakening was observed.RESULTS There was no significant difference in Mo CA scores between the two groups 1 d preoperatively,1 d and 7 d postoperatively(P>0.05).And there was no significant difference in the incidence of postoperative cognitive dysfunction(POCD)between the two groups 1d and 7d postoperatively(P>0.05).Compared with the control group,rc SO_(2) was significantly higher after blood pressure reduction in the trial group(P<0.05),and the maximum decrease in rc SO_(2) was significantly reduced(P<0.05).Compared with the control group,the S100βconcentration immediately after extubation and 1 h after surgery was significantly lower in the trial group(P<0.05),and the IL-6 concentration immediately after extubation was also significantly lower(P<0.05).Compared with the control group,heart rate and MAP were significantly higher in the trial group im

关 键 词：瑞马唑仑 老年人 认知功能障碍 鼻内镜手术 脑氧饱和度 

分 类 号：R971[医药卫生—药品]