摘要
目的观察术中持续泵注瑞马唑仑对蛛网膜下腔阻滞下髋部骨折手术老年患者术后谵妄(POD)的影响。方法选择择期在蛛网膜下腔阻滞下行髋部骨折手术的老年患者236例,男82例,女154例,年龄≥65岁,BMI 18.5~31.0 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:瑞马唑仑组(R组)和对照组(C组),每组118例。在手术部位消毒铺巾时,R组给予首剂量瑞马唑仑0.1 mg/kg,随即以0.2 mg·kg^(-1)·h^(-1)静脉泵注,维持改良警觉/镇静(MOAA/S)评分1或2分,手术结束时停止泵注;C组以相同速率静脉输注等容量生理盐水。采用意识模糊评估法-中文修订版(CAM-CR)于术后1~3 d评估POD的发生情况。记录术前1 d、术后1 d焦虑评分以及入室后、术毕血浆皮质醇浓度。记录术中高血压、低血压、心动过缓、低氧血症和术后恶心呕吐的发生情况。结果与C组比较,R组POD发生率明显降低(P<0.05),术后1 d焦虑评分和术毕血浆皮质醇浓度明显降低(P<0.05),术中高血压发生率明显降低(P<0.05)。两组入室后血浆皮质醇浓度、术中低血压、心动过缓、低氧血症和术后恶心呕吐发生率差异无统计学意义。结论瑞马唑仑可以降低蛛网膜下腔阻滞下行髋部骨折手术的老年患者POD的发生率,可能与缓解术中焦虑、抑制术中应激反应有关。
Objective To observe the effect of intraoperative continuous pump infusion of remimazolam on postoperative delirium(POD)in elderly patients with hip fracture under subarachnoid block.Methods A total of 236 elderly patients undergoing elective hip fracture surgery under subarachnoid block,82 males and 154 females,aged≥65 years,BMI 18.5-31.0 kg/m^(2),ASA physical statusⅠ-Ⅲ,were divided into two groups by using the randomized number table method:remimazolam group(group R)and control group(group C),118 patients in each group.When the surgical site was disinfected and covered,the patients in group R were administered the first dose of reminmazolam 0.1 mg/kg and followed by a continuous infusion 0.2 mg·kg^(-1)·h^(-1)intravenously to maintain the modified observer's assessment of alert/sedation(MOAA/S)1 or 2 scores.Reminmazolam infusion was stopped at the end of the surgery.The same volume of normal saline was injected for patients in group C.POD was assessed by the confusion assessment method-Chinese revised version(CAM-CR)1-3 days after the surgery.The anxiety scores one day before and one day after the surgery,and plasma cortisol concentrations when the patients were admitted into the operating room and at the end of the surgery were recorded.The incidence of intraoperative hypertension,hypotension,bradycardia,hypoxemia,and postoperative nausea and vomiting were also recorded.Results Compared with group C,POD incidence in group R was significantly decreased(P<0.05),anxiety score one day after surgery and plasma cortisol concentration at the end of the surgery in group R were significantly decreased(P<0.05),and the incidence of intraoperative hypertension in group R was significantly decreased(P<0.05).There were no significant differences in the plasma cortisol concentrations when the patients were admitted into the operating room and the incidences of intraoperative hypotension,bradycardia,hypoxemia,and postoperative nausea and vomiting between the two groups.Conclusion Remimazolam can reduce the incidence of postoperative delirium in elderlypatients undergoing hip fracture surgery under subarachnoid block,which may be related to alleviating intraoperative anxiety and inhibiting intraoperative stress response.
作者
刘恒花
杨锦锦
邱迪
滕培兰
杨建军
冯继英
LIU Henghua;YANG Jinjin;QIU Di;TENG Peilan;YANG Jianjun;FENG Jiying(Department of Anesthesiology,the Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2024年第10期1063-1067,共5页
Journal of Clinical Anesthesiology
基金
连云港市赣榆区卫生健康科技项目(202315)。
关键词
瑞马唑仑
术后谵妄
皮质醇
镇静
髋部骨折手术
老年
Remimazolam
Postoperative delirium
Cortisol
Sedation
Hip fracture surgery
Aged
