摘要
目的:探讨不同剂量瑞马唑仑对髋部骨折患者术后谵妄的影响及安全性。方法:选取2020年3月~2021年7月在本院接受髋部骨折手术的患者120例,采用随机数字表法分为对照组(30例)和观察组(90例)。对照组用丙泊酚+依托咪酯麻醉诱导,低、中、高剂量观察组分别静脉注射瑞马唑仑0.25、0.30mg/kg和0.35mg/kg麻醉诱导,观察各组脑电双频指数(BIS)及认知功能变化、术后谵妄发生率及严重程度。结果:观察组各亚组诱导至BIS≤60时间均较对照组缩短,且低、中、高剂量组诱导至BIS≤60时间两两比较均具有统计学差异(P<0.05);低、中、高剂量组术后24h和72h的简易精神状态检查(mini-mental state examination,MMSE)评分均高于对照组(P<0.05);低、中、高剂量组术后3天谵妄发生率分别为10.00%、6.67%和6.67%,均低于对照组(20.00%,P<0.05);低、中、高剂量组谵妄评定量表(confusion assessment method,CAM)评分低于对照组(P<0.05),但观察组各亚组间谵妄发生率及CAM评分均无统计学差异(P>0.05)。结论:瑞马唑仑复合全身麻醉在老年髋部骨折手术中的应用,能缩短麻醉诱导时间,减轻认知功能损伤,预防并减轻术后谵妄症状,且0.25mg/kg剂量安全性更高。
Objective:To investigate the eff ect and safety of diff erent doses of remazolam on postoperative delirium in patients with hip fracture.Methods:A total of 120 patients who underwent hip fracture surgery in our hospital from March 2020 to July 2021 were selected,and divided into the control group(30 cases)and the observation group(90 cases)by random number table method.The control group was induced anesthesia with propofol+etomidate,the low,medium and high dose groups were given intravenous injection of remazolam 0.25,0.30 mg/kg and 0.35 mg/kg to induce anesthesia respectively.The bispectral index(BIS)value,functional changes,incidence and severity of postoperative delirium in the two groups were observed.Results:The time from induction to BIS≤60 in each subgroup of the observation group was shorter than that of the control group,and the time from induction to BIS≤60 in the low-dose,medium-dose and high-dose groups,the pairwise comparison showed statistical diff erence(P<0.05).The scores of mini-mental state examination(MMSE)at 24 h and 72 h after operation in the low-dose,medium-dose and high-dose group were higher than those in control group(P<0.05).The incidences of delirium 3 days after operation in low-dose,medium-dose and high-dose groups were 10.00%,6.67%and 6.67%,respectively,which were lower than 20.00%in control group(P<0.05);the confusion assessment method(CAM)scores of the low-dose,middle-dose and high-dose groups were lower than those of the control group(P<0.05),but there was no signifi cant diff erence in the incidence of delirium and CAM score among the subgroups in the observation group(P>0.05).Conclusion:The application of remazolam combined with general anesthesia in elderly hip fracture surgery can shorten the induction time of anesthesia,reduce cognitive impairment,and prevent and reduce postoperative delirium symptoms.The dose of 0.25 mg/kg is safer.
作者
李孟阳
屈瀚
LI Meng-yang;QU Han(Department of Anesthesia and Perioperative Medicine,General Hospital of Pingmei Shenma Group,Pingdingshan 467000,China)
出处
《中国合理用药探索》
2022年第7期32-37,共6页
Chinese Journal of Rational Drug Use
关键词
瑞马唑仑
剂量
全身麻醉
髋部骨折
老年
谵妄
remazolam
dose
general anesthesia
hip fracture
elderly
delirium
作者简介
李孟阳,男,主治医师,专业方向:临床麻醉。E-mail:385713278@qq.com;通讯作者:屈瀚,男,副主任医师,专业方向:临床麻醉。E-mail:wt467000@163.com。
