瑞马唑仑对非体外循环冠状动脉搭桥术老年患者术后谵妄的影响  

Effect of Remimazolam on Postoperative Delirium in Elderly Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

作　　者：张立媛 杨木强[1] 司建洛[1] 刘伟峰[1] ZHANG Liyuan;YANG Muqiang;SI Jianluo;LIU Weifeng(Department of Anesthesiology,the First Affiliated Hospital of Henan University of Science and Technology,Clinical Medical College of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学第一附属医院/河南科技大学临床医学院麻醉科,河南洛阳471003

出　　处：《河南医学研究》2025年第5期799-805,共7页Henan Medical Research

基　　金：洛阳市2023年度医疗卫生指导性科技计划项目(2302014Y)。

摘　　要：目的探讨瑞马唑仑对非体外循环冠状动脉搭桥术(OPCABG)老年患者术后谵妄(POD)的影响。方法招募于河南科技大学第一附属医院手术室择期行OPCABG的老年患者70例,年龄65~79岁,采用随机数字表法分为试验组与对照组,各35例。试验组麻醉诱导时静脉注射瑞马唑仑0.15~0.35 mg·kg^(-1),麻醉维持时静脉输注瑞马唑仑0.3~1.0 mg·kg^(-1)·h^(-1);对照组麻醉诱导时静脉注射丙泊酚1.0~2.5 mg·kg^(-1),麻醉维持时静脉输注丙泊酚4~12 mg·kg^(-1)·h^(-1)。两组其余的麻醉诱导和维持方法均一致。术后3 d内采用ICU意识障碍评估法(CAM-ICU)进行POD的评估。使用15项恢复质量问卷(QoR-15)在术后第1天和第2天评估恢复质量。记录患者术前及术后1、3 d时的血常规。记录术后麻醉苏醒时间、气管导管拔除时间、ICU停留时间及术后总住院时间。统计和分析术后不良事件发生率。结果术后3 d内,试验组患者有12例(34.3%)发生了POD,有23例(65.7%)未发生POD,对照组患者有14例(40.0%)发生了POD,有21例(60.0%)未发生POD,两组间比较差异均无统计学意义(P>0.05)。试验组患者在术后第1天和第2天的QoR-15评分均较对照组升高(P<0.05)。两组患者术后1 d及3 d的白细胞计数、中性粒细胞计数及中性粒细胞百分比均较术前1 d升高(P<0.05)。试验组术后1 d及3 d的白细胞计数、中性粒细胞计数及中性粒细胞百分比升高幅度均低于对照组(P<0.05)。试验组术后麻醉苏醒时间、气管导管拔除时间及ICU停留时长均短于对照组(P<0.05)。与对照组比较,试验组窦性心动过缓和低血压发生率均下降(P<0.05)。结论瑞马唑仑用于OPCABG老年患者的全身麻醉诱导和维持时不升高POD发生率,且可提高患者术后康复质量。Objective To assess the effects of remimazolam on postoperative delirium(POD)in elderly patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Seventy elderly patients aged 65-79 years old were enrolled in the operating room of the First Affiliated Hospital of Henan University of Science and Technology to receive OPCABG.Random number table method was used to divide the experimental group and the control group,35 cases each.In experimental group,remimazolam was administered intravenously at a dose of 0.15-0.35 mg·kg^(-1)for induction and 0.3-1.0 mg·kg^(-1)·h^(-1)for maintenance of anesthesia.In the control group,propofol was administered intravenously at a dose of 1.0-2.5 mg·kg^(-1)for induction and 4-12 mg·kg^(-1)·h^(-1)for maintenance of anesthesia.Other methods of anesthesia induction and maintenance were consistent between the two groups.POD was assessed within 3 days after surgery using the confusion assessment method for the intensive care unit(CAM-ICU).The quality of recovery was evaluated on the first and second postoperative days using the 15-item quality of recovery questionnaire(QoR-15).Preoperative and postoperative blood routine tests were recorded.The times of anesthesia recovery,extubation,ICU stay,and postoperative hospital stay were recorded.The incidence of postoperative adverse events was statistically analyzed.Results Within 3 days after surgery,12 patients(34.3%)in experimental group experienced POD,while 23 patients(65.7%)did not.In the control group,14 patients(40.0%)experienced POD,while 21 patients(60.0%)did not.There was no statistical significance between the two groups(P>0.05).On the first and second postoperative days,the QoR-15 scores of the patients in experimental group were higher than those in the control group on the first and second days after operation(P<0.05).The white blood cell counts,neutrophil counts,and neutrophil percentages on postoperative days 1 and 3 were elevated compared to preoperative day 1 values in both groups(P<0.05).However,the exp

关 键 词：术后谵妄 瑞马唑仑 丙泊酚 心脏手术 老年人 

分 类 号：R619.9[医药卫生—外科学]