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    瑞马唑仑和咪达唑仑麻醉诱导对老年腹部手术病人麻醉效果和术后认知功能障碍发生的影响

    Influence of anesthesia induction with remimazolam and midazolam on anesthesia effect and occurrence of postoperative cognitive dysfunction in elderly patients with abdominal surgery

      摘要
    • 摘要:
      目的： 探讨瑞马唑仑和咪达唑仑麻醉诱导对老年腹部手术病人麻醉效果和术后认知功能障碍发生的影响。
      方法： 将行腹部手术的110例老年病人按照随机数字表法分为瑞马唑仑组和咪达唑仑组各55例，咪达唑仑组病人予咪达唑仑麻醉诱导，瑞马唑仑组病人予瑞马唑仑麻醉诱导。观察2组病人睫毛反射消失时间、手术时间、麻醉时间、麻醉苏醒时间，血流动力学指标及术后认知功能障碍（POCD）发生情况，统计麻醉术后不良反应。
      结果： 瑞马唑仑组病人睫毛反射消失时间及麻醉苏醒时间均短于咪达唑仑组，差异均有统计学意义（P ＜ 0.05和P ＜ 0.01），2组病人手术时间及麻醉时间差异均无统计学意义（P ＞ 0.05）。术前2组病人心率（HR）、平均动脉压（MAP）及血氧饱和度（SpO2）对比，差异均无统计学意义（P ＞ 0.05）；插管后、手术30 min后及手术结束时，瑞马唑仑组HR及MAP水平均低于咪达唑仑组（P ＜ 0.05），2组SpO2水平差异无统计学意义（P ＞ 0.05）。瑞马唑仑组病人术后24 h、48 h及72 h POCD发生率均低于咪达唑仑组，差异有统计学意义（P ＜ 0.05）。2组病人麻醉后不良反应差异均无统计学意义（P ＞ 0.05）。
      结论： 与咪达唑仑相比，对老年腹部手术病人使用瑞马唑仑麻醉能够更快实现麻醉诱导，缩短病人麻醉术后恢复时间，对血流动力学影响更小，麻醉效果更好，且能够降低病人术后POCD发生风险，具有一定的安全性。

       

      Abstract:
      Objective To explore the influence of anesthesia induction with remimazolam and midazolam on anesthesia effect and postoperative cognitive dysfunction in elderly patients undergoing abdominal surgery.
      Methods A total of 110 elderly patients who underwent abdominal surgery were divided into remimazolam group (55 cases) and midazolam group (55 cases) according to the random number table method. Patients in midazolam group were given midazolam for anesthesia induction, while patients in remimazolam group performed anesthesia induction with remimazolam. The disappearance time of eyelash reflex, surgical time, anesthesia time, anesthesia recovery time, hemodynamic indicators and occurrence of postoperative cognitive dysfunction (POCD) were observed in the two groups, and the adverse reactions after anesthesia were counted.
      Results The disappearance time of eyelash reflex and anesthesia recovery time in remimazolam group were shorter than those in midazolam group (P ＜ 0.05 and P ＜ 0.01), but there was no statistical significance in the surgical time or anesthesia time between the two groups (P ＞ 0.05). Before surgery, there were no statistical differences in heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO2) between the two groups (P ＞ 0.05). After intubation, after 30 min of surgery and at the end of surgery, the HR and MAP in remimazolam group were lower than those in midazolam group (P ＜ 0.05), but there was no statistical difference in SpO2 between the two groups (P ＞ 0.05). The incidence rates of POCD at 24 h, 48 h and 72 h after surgery were lower in remimazolam group than those in midazolam group (P ＜ 0.05). The differences in adverse reactions after anesthesia were not statistically significant between the two groups (P ＞ 0.05).
      Conclusion Compared with midazolam, the use of remazolam anaesthesia for elderly abdominal surgery patients can achieve faster induction of anaesthesia, shorten the patient's recovery time after anaesthesia, has less impact on haemodynamics, better anaesthesia effect, and reduce the risk of postoperative POCD in patients, which is a certain degree of safety.

       

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