摘要
目的探讨瑞马唑仑联合术后氢吗啡酮对老年衰弱患者髋关节置换术中血流动力学及麻醉恢复期的影响。方法选取2022年2月至2024年2月四川省科学城医院的72例需行髋关节置换术的老年衰弱患者,采用随机数字表法分为两组,其中一组接受瑞马唑仑联合术后氢吗啡酮麻醉(瑞马唑仑组),另一组接受异丙酚联合术后氢吗啡酮麻醉(异丙酚组),每组36例。比较两组血流动力学参数、麻醉恢复期参数、40项恢复质量评分量表(quality of recovery-40 questionnaire,QoR-40)、简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、视觉模拟量表(VAS)评分、麻醉相关不良反应。结果两组T_(0)、T_(3)时HR、MAP及T_(1)时HR差异无统计学意义(P>0.05);T_(1)、T_(2)时瑞马唑仑组MAP[T_(1)为(72.13±8.04)mm Hg(1 mm Hg≈0.133 kPa),T_(2)为(74.13±7.18)mm Hg],高于异丙酚组[T_(1)为(68.04±7.89)mm Hg,T_(2)为(63.40±57.36)mm Hg](t=2.178、6.261,均P<0.05);T_(2)时瑞马唑仑组HR(72.36±4.36)次·min^(-1),高于异丙酚组(63.81±5.37)次·min^(-1)(t=7.416,P<0.001)。瑞马唑仑组与异丙酚组间PACU停留时间差异无统计学意义(P>0.05)。瑞马唑仑组术后睁眼时间、拔管时间[(11.21±2.12)min、(12.35±3.21)min],均低于异丙酚组[(13.39±2.06)min、(16.90±4.11)min](t=4.425、5.235,P<0.001)。两组术后6 h VAS评分,差异无统计学意义(P>0.05)。术后12、24 h瑞马唑仑组VAS评分[12 h为(2.41±0.78)分,24 h为(1.71±0.33)分]均低于异丙酚组[12 h为(3.08±0.71)分,24 h为(2.03±0.30)分](t=3.811、4.305,均P<0.001)。两组术后QoR-40评分,差异无统计学意义(P>0.05)。瑞马唑仑组术后MoCA评分、MMSE评分[(23.02±4.15)分、(24.23±3.61)分]均高于异丙酚组[(20.06±3.91)分、(19.78±3.33)分](t=3.115、5.436,均P<0.05)。两组患者伤口出血或开裂、恶心呕吐、低血压、低氧血症差异占比差异均无统计学意义(P>0.05);瑞马唑仑组与异丙酚组总不良反应率差异无统计学意义(P>0.05)。结论瑞马唑仑联合术后氢吗啡酮在老年衰弱患者髋关节置换术中具有良好的血流动力学稳定性及麻醉恢复效果,能够有效减轻术后疼痛,提高认知功能。
Objective To explore the effect of remimazolam combined with postoperative hydromorphone on hemodynamics and anesthesia recovery period in elderly frail patients undergoing hip replacement.Methods The study selected 72 elderly frail patients who required hip arthroplasty in Sichuan Province Scientific City Hospital from February 2022 to February 2024.The patients were divided into two groups using a random number table method,with one group receiving remimazolam combined with postoperative hydromorphone anesthesia(remimazolam group)and the other group receiving propofol combined with postoperative hydromorphone anesthesia(propofol group).The two groups were compared in terms of hemodynamic parameters,anesthesia recovery parameters,40-item Quality of Recovery(QoR-40),Montreal Cognitive Assessment(MoCA),Mini-Mental State Examination(MMSE),Visual Analog Scale(VAS)scores,and anesthesia-related adverse reactions.Results There were no significant differences in heart rate(HR),mean arterial pressure(MAP)at T0 and T_(3),or HR at T_(1) between the two groups(P>0.05).At T_(1) and T_(2),the remimazolam group had higher MAP values(T_(1):(72.13±8.04)mm Hg(1 mm Hg≈0.133 kPa),T_(2):(74.13±7.18)mm Hg)compared to the propofol group(T_(1):(68.04±7.89)mm Hg,T_(2):(63.40±57.36)mm Hg)(t=2.178,6.261,both P<0.05).At T_(2),the remimazolam group had a higher HR(72.36±4.36)times·min^(-1) compared to the propofol group(63.81±5.37)times·min^(-1)(t=7.416,P<0.001).There was no significant difference in Post-Anesthesia Care Unit(PACU)stay time between the two groups(P>0.05).The remimazolam group had a shorter eye-opening time and extubation time((11.21±2.12)min,(12.35±3.21)min)compared to the propofol group((13.39±2.06)min,(16.90±4.11)min)(t=4.425,5.235,both P<0.001).There was no significant difference in VAS scores at 6 hours postoperatively(P>0.05).At 12 hours and 24 hours postoperatively,the remimazolam group had lower VAS scores(12 h:(2.41±0.78),24 h:(1.71±0.33))compared to the propofol group(12 h:(3.08±0.71),24 h:(2.03±0.30))(t=3.811,4.305,P<0.001).There were no significant differences in QoR-40 scores between the two groups(P>0.05).The remimazolam group had higher MoCA scores and MMSE scores((23.02±4.15)scores,(24.23±3.61)scores)than the propofol group((20.06±3.91)scores,(19.78±3.33)scores)(t=3.115,5.436,both P<0.05).There were no significant differences in the incidence of wound bleeding or rupture,nausea and vomiting,hypotension,or hypoxemia between the two groups(P>0.05).The total incidence of adverse reactions was not significantly different between the two groups(P>0.05).Conclusion Remimazolam combined with postoperative hydromorphone has good hemodynamic stability and anesthesia recovery effect in hip replacement in elderly frail patients since it can effectively reduce postoperative pain and improve cognitive function.
作者
林敏
张艳杰
石坤
汪姣
钱敏
陈曦
Lin Min;Zhang Yanjie;Shi Kun;Wang Jiao;Qian Min;Chen Xi(Department of Anesthesiology,Sichuan Science City Hospital,Mianyang 621000,China;Department of Geriatrics,Sichuan Science City Hospital,Mianyang 621000,China;Department of Orthopedics,Deyang People’s Hospital,Deyang 618199,China)
出处
《中国药物应用与监测》
2025年第5期860-864,共5页
Chinese Journal of Drug Application and Monitoring
基金
2021年四川省医学(青年创新)科研课题(S21029)。
