摘要
目的:探讨瑞马唑仑对老年骨折患者外周血Tau水平及谵妄风险的影响。方法:前瞻性选取2022年12月~2025年4月期间某院收治的98例老年骨折患者作为研究对象,采用随机数字表法分为对照组和观察组,每组49例。麻醉诱导阶段,两组均静脉注射枸橼酸舒芬太尼注射液,在此基础上对照组给予丙泊酚乳状注射液,观察组给予注射用甲苯磺酸瑞马唑仑;术中麻醉维持阶段,两组均给予丙泊酚乳状注射液联合枸橼酸舒芬太尼注射液维持基础麻醉状态,并间断追加罗库溴铵注射液以维持适宜的肌肉松弛度。比较两组患者诱导前(T_(0))、插管前1 min(T_(1))、插管即刻(T_(2))、插管后1 min(T_(3))、插管后5 min(T_(4))脑电双频指数(BIS)和应激水平[心率(HR)、平均动脉压(MAP)];比较两组患者术前1天、术后1天和3天外周血Tau水平、术后3天内谵妄发生风险及不良反应发生情况。同时构建中介效应模型分析外周血Tau水平在麻醉药物与术后谵妄风险中的中介作用。结果:两组不同时间点BIS比较均无统计学差异(P>0.05)。观察组T_(1)~T_(4)的MAP均高于对照组,HR均低于对照组(P<0.05);术后1天、3天外周血Tau水平均低于对照组(P<0.05);术后3天内的谵妄发生率(10.20%)低于对照组(26.53%,χ^(2)=4.356,P=0.037)。两组不良反应总发生率比较无统计学差异(P>0.05)。中介效应结果显示,外周血Tau水平作为中介变量,其间接效应占总效应的68.23%。结论:瑞马唑仑可有效降低老年骨折患者术后外周血Tau水平,减少术后谵妄的发生风险,且外周血Tau水平在麻醉药物与术后谵妄风险间起重要的中介作用。
Objective:To investigate the effect of remimazolam on peripheral blood Tau levels and the risk of delirium in elderly patients with fractures.Methods:A total of 98 elderly patients with fractures admitted to a hospital from December 2022 to April 2025 were prospectively selected and assigned to the control group and the observation group using random number table method,with 49 patients in each group.During the induction of anesthesia,both groups received intravenous sufentanil citrate injection.Following this,the control group received propofol injectable emulsion,while the observation group received remimazolam tosilate for injection.During the maintenance of intraoperative anesthesia,both groups received propofol injectable emulsion combined with sufentanil citrate injection to maintain baseline anesthetic state,and rocuronium bromide injection was intermittently administered to maintain adequate muscle relaxation.The bispectral index(BIS)and stress level[heart rate(HR),mean arterial pressure(MAP)]at preinduction(T_(0)),1 min pre-intubation(T_(1)),immediately after intubation(T_(2)),1 min post-intubation(T_(3))and 5 min post-intubation(T_(4))were compared between the two groups.Moreover,peripheral blood Tau levels at 1 day pre-surgery,1 day post-surgery and 3 days post-surgery,and the risk of delirium within 3 days post-surgery,as well as adverse reactions were compared between the two groups.Meanwhile,a mediation effect model was constructed to analyze the mediating role of peripheral blood Tau levels between the anesthetic agents and the risk of postoperative delirium.Results:No statistically significant differences in BIS were observed between the two groups at different time points(P>0.05).Compared with the control group,the observation group showed higher MAP and lower HR at T_(1)~T_(4)(P<0.05).Peripheral blood Tau levels at 1 day post-surgery and 3 days post-surgery in the observation group were lower than those in the control group(P<0.05).The incidence of delirium within 3 days post-surgery in the observation group(10.20%)was lower than that in the control group(26.53%,χ^(2)=4.356,P=0.037).No statistically significant difference in the total incidence of adverse reactions was observed between the two groups(P>0.05).The results of mediation effect analysis showed that peripheral blood Tau levels acted as a mediator,with the indirect effect accounting for 68.23%of the total effect.Conclusion:Remimazolam can effectively decrease postoperative peripheral blood Tau levels and reduce the risk of postoperative delirium in elderly patients with fractures.Furthermore,peripheral blood Tau levels play a significant mediating role between the anesthetic agents and the risk of postoperative delirium.
作者
任志强
李晓蕾
范雪娇
周志文
REN Zhi-qiang;LI Xiao-lei;FAN Xue-jiao;ZHOU Zhi-wen(Department of Critical Care Medicine,Shangqiu Municipal Hospital,Shangqiu 476000,China)
出处
《中国合理用药探索》
2025年第12期75-82,共8页
Chinese Journal of Rational Drug Use
关键词
瑞马唑仑
老年骨折
外周血Tau水平
谵妄
应激水平
remimazolam
elderly fractures
peripheral blood Tau levels
delirium
stress levels
