摘要
目的:探讨羟考酮复合瑞马唑仑在胸腰椎单节段椎体骨质疏松性椎体压缩骨折(OVCF)老年患者经皮球囊扩张椎体后凸成形术(PKP)中的镇静镇痛效果及安全性。方法:选取90例胸腰椎单节段OVCF老年患者,随机分为对照组和研究组,每组45例。所有患者均接受局部麻醉联合镇静镇痛监护下保留自主呼吸PKP治疗。对照组给予舒芬太尼复合瑞马唑仑监护麻醉,研究组给予羟考酮复合瑞马唑仑监护麻醉。以脑电双频指数(BIS)和伤害指数(NOX)个体化监测镇静镇痛深度。比较两组患者手术时间、镇静起效时间、苏醒质量、麻醉相关不良反应,以及麻醉前(T0)、局麻后(T1)、穿刺针进入椎体时(T2)、球囊扩张时(T3)、注入骨水泥时(T4)和术毕(T5)时两组血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))]、BIS、NOX变化情况。结果:两组一般资料、手术时间比较差异无统计学意义(均P>0.05)。T0时,两组MAP、BIS及NOX比较差异无统计学意义(均P>0.05)。T1-T5同时间点的MAP、HR、BIS组间比较差异无统计学意义(均P>0.05)。研究组在T1时的NOX低于对照组,在T2-T3时的SpO_(2)高于对照组(均P<0.05)。两组患者镇静起效时间、苏醒时改良警觉性和镇静评分量表(MOAA/S)评分、数字评价量表(NRS)评分及蒙特利尔认知评估量表(MoCA)评分比较差异无统计学意义(均P>0.05)。研究组术中呼吸抑制发生率显著低于对照组(P<0.05)。结论:羟考酮复合瑞马唑仑镇静镇痛麻醉用于胸腰椎单节段OVCF老年患者PKP手术,具有良好的镇静镇痛效果及安全性。
Objective:To investigate the sedative and analgesic effects and safety of oxycodone combined with remimazolam in elderly patients with single-segment osteoporotic vertebral compression fractures(OVCF)of the thoracolumbar spine undergoing percutaneous kyphoplasty(PKP).Methods:A total of 90 elderly patients with single-segment OVCF of thoracolumbar spine were selected and randomly divided into the control group and the study group,with 45 patients in each group.All patients received PKP treatment under local anesthesia combined with sedation and analgesia monitoring while maintaining spontaneous breathing.The control group was given sufentanil combined with remimazolam for monitoring anesthesia,and the study group was given oxycodone combined with remimazolam for monitoring anesthesia.The depth of sedation and analgesia was monitored individually using BIS and NOX.The surgical time,onset time of sedation,quality of awakening,anesthesia-related adverse reactions,as well as the hemodynamic indicators(MAP,HR,SpO_(2))and changes in BIS and NOX at T0(before anesthesia),T1(after local anesthesia),T2(when the puncture needle entered the vertebral body),T3(during balloon dilation),T4(when the bone cement was injected),and T5(at the end of the surgery)were compared between the two groups.Results:There was no statistically significant difference in general data and operation time between the two groups(all P>0.05).At T0,there was no statistically significant difference in MAP,BIS and NOX between the two groups(all P>0.05).At the same time points from T1 to T5,there was no statistically significant difference in MAP,HR and BIS between the two groups(all P>0.05).The NOX of the study group at T1 was lower than that of the control group,and the SpO_(2) of the study group at T2 to T3 was significantly higher than that of the control group(all P<0.05).There was no statistically significant difference in the onset time of sedation,MOAA/S score,NRS score and MoCA score between the two groups(all P>0.05).The incidence of respiratory depression during the operation in the study group was significantly lower than that in the control group(P<0.05).Conclusion:The combination of oxycodone and remimazolam for sedation and analgesia anesthesia in elderly patients with single-segment OVCF of the thoracolumbar spine undergoing PKP shows good sedative and analgesic effects as well as safety.
作者
刘慧敏
岑艳芳
易虎
黄助军
郑铭陟
唐林
LIU Huimin;CEN Yanfang;YI Hu;HUANG Zhujun;ZHENG Mingzhi;TANG Lin(Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou 412007,China)
出处
《陕西医学杂志》
2026年第3期380-384,389,共6页
Shaanxi Medical Journal
基金
湖南省自然科学基金资助项目(2024JJ7664)。
