| 摘要: |
| ［摘要］ 目的 观察瑞马唑仑对体外循环(CPB)下心脏瓣膜置换手术老年患者的应用效果。方法 招募2022年6月至2023年6月郑州人民医院收治的择期行CPB下心脏瓣膜置换手术的老年患者334例，采用随机数字表法将其分为瑞马唑仑组(R组)和丙泊酚组(P组)，每组167例，根据剔除标准最终分别纳入160例和159例。R组麻醉诱导时静脉注射瑞马唑仑0.2～0.3 mg/kg，麻醉维持时静脉泵注瑞马唑仑0.5～1.0 mg/（kg·h）；P组麻醉诱导时静脉注射丙泊酚1.0～2.0 mg/kg，麻醉维持时静脉泵注丙泊酚4～10 mg/（kg·h）。两组其余的麻醉诱导和维持均一致。于术后3 d内采用重症监护室意识障碍评估法(CAM-ICU)评判术后谵妄（POD）的发生情况。比较两组手术及麻醉相关指标、POD发生情况、视觉模拟量表(VAS)评分、Ramsay镇静量表评分及术中、术后不良事件发生情况。结果 与P组比较，R组患者术后麻醉苏醒时间、拔除气管导管时间、ICU停留时间及住院时间更短，差异均有统计学意义(P<0.05)。两组POD发生率、严重程度及持续时间比较差异均无统计学意义（P>0.05）。两组术后不同时间点VAS评分和Ramsay镇静量表评分比较差异均无统计学意义(P>0.05)。R组术中窦性心动过缓和低血压发生率低于P组，差异有统计学意义(P<0.05)。结论 与丙泊酚比较，瑞马唑仑用于CPB下心脏瓣膜置换手术老年患者的全身麻醉诱导和维持不会提高POD发生率，且安全性良好，有助于患者术后快速康复。 |
| 关键词: 瑞马唑仑 丙泊酚 术后谵妄 心脏手术 全身麻醉 老年人 |
| DOI：10.3969/j.issn.1674-3806.2024.02.09 |
| 分类号:R 619 |
| 基金项目:河南省医学科技攻关计划-联合共建项目（编号：LHGJ20220799） |
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| Observation on the application effect of remimazolam on elderly patients undergoing heart valve replacement surgery under cardiopulmonary bypass |
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FAN Qing, ZHU Shuangshuang, MENG Huifang, ZHANG Xungong
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Department of Anesthesiology, People′s Hospital of Zhengzhou, Henan 450000, China
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| Abstract: |
| ［Abstract］ Objective To observe the application effect of remimazolam on elderly patients undergoing heart valve replacement surgery under cardiopulmonary bypass(CPB). Methods Three hundred and thirty-four elderly patients admitted to People′s Hospital of Zhengzhou for elective cardiac valve replacement surgery under CPB from June 2022 to June 2023 were recruited and divided into remimazolam group(group R) and propofol group(group P) by random number table method, with 167 cases in each group, and according to the exclusion criteria, 160 and 159 cases were finally included in the group R and the group P, respectively. The group R was injected with remimazolam intravenously at 0.2-0.3 mg/kg during anesthesia induction, and was pumped with remimazolam intravenously at 0.5-1.0 mg/(kg·h) during anesthesia maintenance. The group P was injected with propofol intravenously at 1.0-2.0 mg/kg during anesthesia induction, and was pumped with propofol intravenously at 4-10 mg/(kg·h) during anesthesia maintenance. The rest of the anesthesia induction and maintenance were consistent in both groups. The occurrence of postoperative delirium(POD) was assessed by using confusion assessment method-intensive care unit(CAM-ICU) within 3 days after surgery. The indicators related to surgery and anesthesia, the occurrence of POD, Visual Analogue Scale(VAS) score, Ramsay Sedation Scale score, and intraoperative and postoperative adverse events were compared between the two groups. Results Compared with those in the group P, the patients in the group R had shorter postoperative anesthesia recovery time, shorter tracheal catheter removal time, shorter intensive care unit(ICU) stay time and hospital stay time, and the differences were statistically significant(P<0.05). There were no significant differences in the incidence rate, severity and duration of POD between the two groups(P>0.05). There were no significant differences in the postoperative VAS scores and Ramsay Sedation Scale scores between the two groups(P>0.05) at postoperative different time points. The incidence rates of intraoperative sinus bradycardia and hypotension in the group R were lower than those in the group P, and the differences were statistically significant(P<0.05). Conclusion Compared with that of propofol, the application of remimazolam in the induction and maintenance of general anesthesia in elderly patients undergoing heart valve replacement surgery under CPB does not increase the incidence rate of POD, and it is safe and helpful for rapid postoperative recovery of the patients. |
| Key words: Remimazolam Propofol Postoperative delirium(POD) Cardiac surgery General anesthesia The elderly |
