瑞马唑仑与咪达唑仑对老年骨科手术全麻术后认知功能影响的对比研究  

Comparative study on the effects of remazolam and midazolam on cognitive function after general anesthesia in elderly orthopedic surgery

作　　者：张凯 王金鹏 徐冰 宁雷 赵静 ZHANG Kai;WANG Jinpeng;XU Bing;NING Lei;ZHAO Jing(Department of Anesthesiology,Traditional Chinese Medicine Hospital in Zhangqiu District,Jinan,Shandong 250200,China)

机构地区：[1]济南市章丘区中医医院麻醉科,山东济南250200

出　　处：《社区医学杂志》2024年第22期762-768,共7页Journal Of Community Medicine

基　　金：2022年度山东省医学会舒适化医疗-基层优化专项资金(YXH2022ZX04247)。

摘　　要：目的比较甲苯磺酸瑞马唑仑注射液与咪达唑仑注射液用于老年患者骨科手术全身麻醉中的临床效果及安全性。方法选取济南市章丘区中医医院老年骨科2023-09-01-12-31择期手术的患者220例,按照计算机软件随机化分组分为观察组与对照组各110例。观察组麻醉诱导时静脉给予瑞马唑仑0.2 mg/kg,对照组麻醉诱导时静脉给予咪达唑仑0.03 mg/kg,其他用药均为舒芬太尼、罗库溴铵、丙泊酚,2组患者术中维持均用微量泵输注丙泊酚与瑞芬太尼。重复测量的方差分析比较2组患者在麻醉诱导时(T0)、脑电双频指数(BIS)<60时(T1)、气管插管后(T2)3个时间点的心率(HR)和平均动脉压(MAP);以麻醉药物停输时间为起点,独立样本t检验比较2组患者睁眼时间(Ts-o)、拔管时间(To-d)、在麻醉复苏室(PACU)停留时间(Tpacu);重复测量的方差分析比较手术前、手术后6、12与24 h内简易精神状态评价量表(MMSE)得分情况;χ^(2)检验比较术后出现不良反应情况。结果220例受试者均已全部入组,观察组和对照组在T0点的MAP分别为(83.04±12.17)和(82.29±12.91)mmHg,T1点MAP分别为(73.02±9.58)和(66.51±11.31)mmHg,T2点MAP分别为(83.75±9.67)和(86.75±10.10)mmHg,2组患者MAP均呈现先降后升的趋势,观察组的MAP波动程度低于对照组,2组患者时间点、组间与时间点间的交互作用差异有统计学意义,均P<0.05;观察组和对照组在T0点的HR分别为(75.90±10.49)和(76.25±10.49)次/min,T1点HR分别为(75.32±7.20)和(83.81±6.79)次/min,T2点HR分别为(90.15±6.89)和(102.59±6.82)次/min,2组患者HR呈现逐步升高的趋势,观察组HR升高程度低于对照组。组间、时间点、组间与时间点间的交互作用差异有统计学意义,均P<0.05;观察组和对照组Ts-o分别为(4.47±1.43)和(6.01±1.55)min,To-d分别为(1.86±0.70)和(2.78±0.78)min,Tpacu分别为(19.32±3.55)和(21.82±3.30)min,与对照组相比,观察组Ts-o、To-d和Tpacu 3个时间段�Objective To compare the clinical efficacy and safety of remimazolam tosilate injection and midazolam injection for general anesthesia in elderly patients undergoing orthopedic surgery. Methods Totally 220 patients who underwent elective surgery in the Department of Geriatric Orthopedics at Traditional Chinese Medicine Hospital in Zhangqiu district,Jinan city from September 1to December 31in 2023were selected,and were randomly divided into an observation group and a control group,with 110cases in each group by computer software.The observation group received 0.2mg/kg of remazolam intravenously during anesthesia induction,while the control group received 0.03mg/kg of midazolam intravenously during anesthesia induction.Other drugs used were sufentanil,rocuronium,and propofol.Both groups maintained anesthesia with a microinfusion of propofol and remifentanil during surgery.Repeated measures ANOVA was used to compare the heart rate(HR)and mean arterial pressure(MAP)of two groups of patients at three time points:anesthesia induction(T0),bispectral index(BIS)<60(T1),and intubation(T2);Starting from the cessation time of anesthesia drugs,a heavy independent sample t-test was used to compare the eye opening time(Ts-o),extubation time(To-d),and stay time in the post-anesthesia care unit(Tpacu)between two groups of patients;Repeated measures ANOVA was used to compare the scores of the mini mental state examination(MMSE)before surgery and at 6,12,and 24hours after surgery;Chi-square tests were used to compare the incidence of adverse reactions after surgery.Results All 220subjects were enrolled.The MAP of the observation group and the control group at T0was(83.04±12.17)and(82.29±12.91)mmHg;at T1,(73.02±9.58)and(66.51±11.31)mmHg,respectively;and at T2,(83.75±9.67)and(86.75±10.10)mmHg,respectively.The MAP of the two groups showed a trend of decreasing first and then increasing.The fluctuation degree of MAP in the observation group was lower than that in the control group.The differences in time points,groups,and the int

关 键 词：瑞马唑仑 咪达唑仑 全身麻醉 老年人 骨科 

分 类 号：R971.2[医药卫生—药品]