不同剂量瑞马唑仑对老年全身麻醉患者心率变异性及认知功能的影响  

Effects of different doses of remazolam on heart rate variability and cognitive function in elderly patients undergoing general anesthesia

作　　者：任静 王鹏飞 REN Jing;WANG Pengfei(Department of Anesthesiology,Xi′an Chang′an District Hospital,Xi′an 710118,Shaanxi Province,China;Department of Anesthesiology,the Second Affiliated Hospital of Xi′an Medical University,Xi′an 710038,Shaanxi Province,China)

机构地区：[1]西安市长安区医院麻醉科,陕西西安710118 [2]西安医学院第二附属医院麻醉科,陕西西安710038

出　　处：《新乡医学院学报》2025年第1期57-61,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨不同剂量瑞马唑仑对老年全身麻醉患者心率变异性及认知功能的影响。方法选择2020年3月至2023年3月西安医学院第二附属医院收治的行全身麻醉手术的93例老年患者为研究对象,按随机数字表法将患者分为低剂量组、中剂量组、高剂量组,每组31例。低剂量组、中剂量组、高剂量组患者分别静脉注射0.2、0.3、0.4 mg·kg^(-1)瑞马唑仑。分别于麻醉诱导前(T_(1))、给药后即刻(T_(2))、气管插管即刻(T_(3))、拔管后即刻(T_(4))、拔管后10 min(T_(5)),使用动态心电图仪检测患者的总频(TF)、低频(LF)、高频(HF)等心率变异性指标,并计算LF/HF比值;使用心电监护仪检测患者的平均动脉压(MAP)和无创脉搏血氧饱和度(SpO_(2)),使用麻醉深度检测仪检测患者的脑电双频指数(BIS)。采用简易智能精神状态检查量表(MMSE)评估患者术后7 d的认知功能。记录3组患者入睡时间、苏醒时间、拔管时间、麻醉恢复室(PACU)停留时间等麻醉恢复指标和瑞马唑仑补救情况。记录患者低氧血症、心动过缓、注射痛、谵妄等不良反应发生情况,并计算总不良反应发生率。结果重复测量方差分析显示,TF、LF/HF、MAP存在时间点效应、交互效应(F=8.246、7.123、7.159、8.141、8.004、7.566,P<0.001),不存在组间效应(F=0.552、0.670、0.536,P>0.05);T_(1)至T_(5)时,3组患者的TF、LF/HF、MAP呈降低-升高趋势(P<0.05)。SpO_(2)不存在组间效应、时间点效应、交互效应(F=1.135、1.556、0.489,P>0.05)。BIS存在时间点效应、交互效应(F=7.770、9.123,P<0.001),不存在组间效应(F=1.005,P>0.05);T_(1)至T_(5)时,3组患者的BIS呈降低-升高趋势(P<0.05)。术后7 d,低剂量组、中剂量组、高剂量组患者认知功能障碍(POCD)发生率分别为0.00%(0/31)、3.23%(1/31)、9.68%(3/31),3组患者POCD发生率比较差异无统计学意义(χ^(2)=3.657,P>0.05)。MMSE评分存在时间点效应、交互效应(F=7.009、7.256,P<0.0Objective To investigate the effects of different doses of remazolam on heart rate variability and cognitive function of elderly patients undergoing general anesthesia.Methods A total of 93 elderly patients with general anesthesia in the Second Affiliated Hospital of Xi′an Medical University from March 2020 to March 2023 were selected.They were divided into low-,medium-and high-dose groups by the random number table method,with 31 cases in each group.The low-,medium-and high-dose groups were given 0.2,0.3 and 0.4 mg·kg^(-1) remazolam,respectively.Heart rate variability indexes including total frequency(TF),low frequency(LF),and high frequency(HF)were detected by dynamic electrocardiograph before anesthesia induction(T_(1)),right after administration(T_(2)),at endotracheal intubation(T_(3)),right after extubation(T_(4))and 10 min after extubation(T_(5)).The LF/HF ratio was calculated.The mean arterial pressure(MAP)and the pulse oxygen saturation(SpO_(2))level were measured by an electrocardiogram monitor.The bispectral index(BIS)of patients was detected by an anesthesia depth detector.The mini-mental state examination(MMSE)was used to evaluate the cognitive function of patients 7 days after surgery.Indicators of recovery from anesthesia including sleeping time in bed,wake-up time,extubation time,and postanesthesia care unit(PACU)stay time and the supplementation of remazolam were recorded.The adverse reactions such as hypoxemia,bradycardia,injection pain and delirium were recorded and the total incidence of adverse reactions was calculated.Results The repeated measures analysis of variance showed that TF,LF/HF,and MAP had time and interaction effects(F=8.246,7.123,7.159,8.141,8.004,7.566,P<0.001),but no intergroup effect(F=0.552,0.670,0.536,P>0.05).From T_(1) to T_(5),TP,LF/HF,and MAP first decreased and then increased in all the three groups(P<0.05).SpO_(2) levels had no intergroup,time or interaction effect(F=1.135,1.556,0.489;P>0.05).BIS had time and interaction effects(F=7.770,9.123,P<0.001),but no intergro

关 键 词：全身麻醉 瑞马唑仑 心率变异性 认知功能障碍 

分 类 号：R614.2[医药卫生—麻醉学]