摘要
目的探究瑞马唑仑复合全麻对老年髋部骨折患者术后谵妄及血清Aβ-42淀粉样蛋白(Aβ-42)、Tau蛋白的影响。方法前瞻性收集2023年5月至2024年3月于我院行髋关节置换手术的122例老年患者纳入研究,男63例、女59例,年龄(73.52±3.77)岁。采用随机数字表法将患者分为R组(瑞马唑仑组)和P组(丙泊酚组),每组61例。记录两组患者诱导前(T0)、插管前1 min(T1)、插管即刻(T2)、插管后1 min(T3)、插管后3 min(T4)、插管后5 min(T5)的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS);随访并记录患者术后1 d(T6)、2 d(T7)、3 d(T8)术后谵妄的发生率;血清Aβ-42、Tau蛋白及恶心呕吐、注射痛、心动过缓、低血压等不良反应等。结果R组和P组T0、T1、T2、T3、T4、T5进行重复HR水平测量设计的方差分析显示,R组和P组组间差异有统计学意义(P<0.05),组别与时间点间存在交互作用(P<0.05),各时间点除T0点外两组差别均有统计学意义(P<0.05);两组时间点间差异均无统计学意义(P>0.05)。R组和P组T0、T1、T2、T3、T4、T5进行重复MAP水平测量设计的方差分析显示,R组和P组组间差异有统计学意义(P<0.05),组别与时间点间存在交互作用(P<0.05),各时间点除T0点外两组差别均有统计学意义(P<0.05);两组时间点间差异均有统计学意义(P<0.05)。R组和P组T0、T1、T2、T3、T4、T5进行重复BIS水平测量设计的方差分析显示,R组和P组组间差异无统计学意义(P>0.05),组别与时间点间无交互作用(P>0.05),各时间点两组差别均无统计学意义(P<0.05);两组时间点间差异均有统计学意义(P<0.05)。R组术后T6的谵妄发生率低于P组(P<0.05),两组T7、T8的谵妄发生率无显著差异(P>0.05)。R组和P组术前、术后3 d在Aβ-42、Tau蛋白水平进行重复测量设计的方差分析显示,两组组间差异有统计学意义(P<0.05),组别与时间点间存在交互作用(P<0.05),术后3 d两组差别均有统计学意义(P<0.05);两组在术前、术后3 d的差异均有统计学意义(P<0.05)。R组患者不良反应发生率低于P组(P<0.05)。结论瑞马唑仑复合全麻可有效缓解老年髋部骨折患者麻醉诱导期间的心率和血压波动,降低术后谵妄和麻醉不良反应发生率。
Objective To explore the effects of remimazolam combined with general anesthesia on postoperative delirium,serum Aβ-42 amyloid protein(Aβ-42)and Tau protein in elderly patients with hip fracture.Methods A total of 122 elderly patients undergoing hip replacement in the hospital were enrolled between May 2023 and March 2024.There were 63 males and 59 females,with an age of 73.52±3.77 years.According to random number table method,they were divided into group R(remimazolam group)and group P(propofol group),61 cases in each group.The mean arterial pressure(MAP),heart rate(HR)and bispectral index(BIS)before induction(T0),at 1min before intubation(T1),immediately after intubation(T2),at 1min after intubation(T3),3min after intubation(T4)and 5min after intubation(T5),incidence of postoperative deliriumat 1 d(T6),2 d(T7)and 3 d(T8)after surgery by follow-up,serum Aβ-42,Tau protein and adverse reactions(nausea and vomiting,injection pain,bradycardia,hypotension)in the two groups were recorded.Results Repeated ANOVA showed that there were significant differences in HR between the two groups at T0,T1,T2,T3,T4 and T5(P<0.05),and there was interaction between group and time point(P<0.05),and differences between the two groups were statistically significant at all time points except T0(P<0.05).There was no significant difference in HR at different time points in either group(P>0.05).Repeated ANOVA showed that there were significant differences in MAP between the two groups at T0,T1,T2,T3,T4 and T5(P<0.05),and there was interaction between group and time point(P<0.05),and differences between the two groups were statistically significant at all time points except T0(P<0.05).There were significant difference in MAP at different time points in both groups(P<0.05).Repeated ANOVA showed that there was no significant difference in BIS between the two groups at T0,T1,T2,T3,T4 and T5(P>0.05),and there was no interaction between group and time point(P>0.05),and difference between the two groups was not statistically significant at any time point(P>0.05).There were significant differences in BIS at different time points in both groups(P<0.05).At T6,incidence of delirium in group R was lower than that in group P(P<0.05),but there was no significant difference in the incidence of delirium between the two groups at T7 and T8(P>0.05).Repeated ANOVA showed that there were significant differences in levels of serum Aβ-42 and Tau protein between the two groups before and at 3 d after surgery(P<0.05),and there was interaction between group and time point(P<0.05),and differences between the two groups were statistically significant at 3 d after surgery(P<0.05).There were significant differences in levels of serum Aβ-42 and Tau protein before and at 3 d after surgery in both groups(P>0.05).The incidence of adverse reactions in group R was lower than that in group P(P<0.05).Conclusion Remimazolam combined with general anesthesia can effectively alleviate heart rate and blood pressure fluctuation in elderly patients with hip fractureduring anesthesia induction,reduce the incidence of postoperative delirium and adverse anesthesia reactions.
作者
李科佶
诸源江
李培玉
Li Keji;Zhu Yuanjiang;Li Peiyu(Anesthesiology Department of Sichuan Orthopedic Hospital,Chengdu 610041,China)
出处
《中华老年骨科与康复电子杂志》
2025年第4期231-236,共6页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
中国红十字基金会医学赋能公益专项基金"医学赋能及人才培养计划"临床科研项目(CRCF-YXFN-202001152)。
作者简介
通信作者:李培玉,Email:65223091@qq.com。
