瑞马唑仑在脑梗死血管内介入手术麻醉中的应用及对术后谵妄防治效果  

Application of Remimazolam in anesthesia for endovascular therapy in cerebral infarction and its preventive and therapeutic effects on postoperative delirium

作　　者：樊腾[1] 李晓芳[1] 张红伟[1] 田建民[1] 马闻苛 岳修勤[1] FAN Teng;LI Xiaofang;ZHANG Hongwei;TIAN Jianmin;MA Wenke;YUE Xiuqin(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical University,Henan,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院麻醉与围术期医学科,河南新乡453100

出　　处：《中国医药科学》2024年第20期90-93,共4页China Medicine And Pharmacy

基　　金：新乡医学院第一附属医院青年培育基金项目(QN-2022-B05)。

摘　　要：目的 观察瑞马唑仑在脑梗死血管内介入手术(EVT)麻醉中的应用,及对术后谵妄的防治效果。方法本研究为前瞻性研究,选择2021年1月至2023年7月新乡医学院第一附属医院收治的125例脑梗死患者为研究对象,以计算机随机分组法将其分为常规组(62例)和试验组(63例),所有患者均接受EVT治疗,常规组实施常规全身麻醉,试验组采用瑞马唑仑辅助麻醉,比较两组患者γ-氨基丁酸(GABA)受体变化情况、清醒后即刻认知功能、术后谵妄发生情况及苏醒情况。结果 试验组术后12、24、48 h的GABA水平均低于常规组,差异有统计学意义(P <0.05)。试验组清醒后即刻的简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分均高于常规组,差异有统计学意义(P <0.05)。试验组术后谵妄发生率、Ramsay镇静评分(RSS)均低于常规组,差异有统计学意义(P <0.05)。试验组术后苏醒时间、麻醉苏醒室(PACU)留观时间略高于常规组,但差异无统计学意义(P> 0.05)。结论 瑞马唑仑能改善患者术后即刻认知功能并通过抑制GABA活性而降低术后谵妄发生风险。Objective To observe the application of Remimazolam in anesthesia for endovascular therapy(EVT)for cerebral infarction and its preventive and therapeutic effects on postoperative delirium.Methods This study was a prospective study.125 patients with cerebral infarction who were admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2021 to July 2023 were selected as the study subjects,and were randomly divided into a conventional group(62 cases)and an experimental group(63 cases)using computer randomization.All patients were treated with EVT,with the conventional group receiving conventional general anesthesia and the experimental group receiving Remimazolam as adjuvant anesthesia.The changes inγ-aminobutyric acid(GABA)receptor,cognitive function immediately after awakening,incidence of postoperative delirium,and recovery status of the two groups of patients were compared.Results The GABA level in the experimental group were lower than those in the conventional group at 12,24 and 48 h after operation,and the differences were statistically significant(P<0.05).The scores of mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)in the experimental group were higher than those in the conventional group,and the differences were statistically significant(P<0.05).The incidence of postoperative delirium and Ramsay sedation scale(RSS)in the experimental group were lower than those in the conventional group,and the differences were statistically significant(P<0.05).The recovery time after operation and the stay time in the post-anesthesia care init(PACU)in the experimental group were slightly longer than those in the conventional group,with no statistically significant difference(P>0.05).Conclusion Remimazolam can improve immediate postoperative cognitive function in patients and reduce the risk of postoperative delirium by inhibiting GABA activity.

关 键 词：脑梗死 血管内介入治疗 瑞马唑仑 术后谵妄 Γ-氨基丁酸 

分 类 号：R614[医药卫生—麻醉学]