[1]刘 璐.瑞马唑仑联合气管插管全身麻醉在老年髋部骨折内固定术中的应用[J].医学信息,2023,36(19):97-101.[doi:10.3969/j.issn.1006-1959.2023.19.020]
　LIU Lu.Application of Remimazolam Combined with Tracheal Intubation General Anesthesia in Elderly Patients with Hip Fracture Internal Fixation[J].Journal of Medical Information,2023,36(19):97-101.[doi:10.3969/j.issn.1006-1959.2023.19.020]
点击复制

瑞马唑仑联合气管插管全身麻醉在老年髋部骨折内固定术中的应用()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年19期
页码:
97-101
栏目:
论著
出版日期:
2023-10-01

文章信息/Info

Title:
Application of Remimazolam Combined with Tracheal Intubation General Anesthesia in Elderly Patients with Hip Fracture Internal Fixation
文章编号:
1006-1959（2023）19-0097-05
作者:
刘 璐
（徐州医科大学附属医院麻醉科，江苏 徐州 221000）
Author(s):
LIU Lu
(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China)
关键词:
髋部骨折; 瑞马唑仑; 气管插管; 全身麻醉; 认知功能
Keywords:
Hip fracture; Remimazolam; Tracheal intubation; General anesthesia; Cognitive function
分类号:
R614；R687.3
DOI:
10.3969/j.issn.1006-1959.2023.19.020
文献标志码:
A
摘要:
目的 观察瑞马唑仑联合气管插管全身麻醉在老年髋部骨折内固定术中的应用效果。方法 选择2020年3月-2022年5月在我院行髋部骨折内固定术治疗的68例患者为研究对象，将其随机分为对照组（34例）和观察组（34例），对照组给予丙泊酚联合依托咪酯麻醉，观察组静脉注射瑞马唑仑，比较两组麻醉效果，并记录患者入手术室前、麻醉完成后、手术开始后以及术毕时的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2），统计患者围术期不良反应发生率，采用简易智力状态评定量表（MMSE）评估患者认知功能变化情况。结果 两组插管前BIS值比较，差异无统计学意义（P＞0.05）；观察组诱导至BIS≤60时间短于对照组（P＜0.05）；观察组麻醉完成后、手术开始后及术毕时SpO2与对照组比较，差异无统计学意义（P＞0.05）；观察组麻醉完成后、手术开始后及术毕时HR低于对照组，手术开始后MAP低于对照组（P＜0.05）；观察组围术期不良反应发生率（8.82%）低于对照组（29.41%）（P＜0.05）；两组术后6 h瞬时记忆、定向力及短暂记忆等认知功能评分均下降，但观察组瞬时记忆、定向力及短暂记忆等认知功能评分高于对照组（P＜0.05）。结论 瑞马唑仑联合气管插管全身麻醉应用于老年髋部骨折内固定术中可减轻患者认知功能，维持生命体征稳定，安全性高，不良反应少，值得临床应用。
Abstract:
Objective To observe the application effect of remimazolam combined with tracheal intubation general anesthesia in elderly patients with hip fracture internal fixation.Methods A total of 68 patients who underwent hip fracture internal fixation in our hospital from March 2020 to May 2022 were selected as the research objects. They were randomly divided into control group (34 patients) and observation group (34 patients). The control group was given propofol combined with etomidate anesthesia, and the observation group was given intravenous injection of remimazolam. The anesthetic effects of the two groups were compared. The heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) of the patients before entering the operating room, after anesthesia, after operation and at the end of operation were recorded. The incidence of perioperative adverse reactions was counted. Mini-mental state examination (MMSE) was used to evaluate the changes of cognitive function in patients.Results There was no significant difference in BIS value between the two groups before intubation (P>0.05). The time from induction to BIS≤60 in the observation group was shorter than that in the control group (P<0.05). There was no significant difference in SpO2 after the completion of anesthesia, after the beginning of surgery and at the end of surgery between the observation group and the control group (P>0.05). The HR after anesthesia, after operation and at the end of operation of the observation group was lower than that of the control group, and the MAP after operation was lower than that of the control group (P<0.05). The incidence of perioperative adverse reactions in the observation group (8.82%) was lower than that in the control group (29.41%) (P<0.05). The scores of cognitive function such as instantaneous memory, directional force and transient memory in the two groups decreased at 6 h after operation, but the scores of cognitive function such as instantaneous memory, directional force and transient memory in the observation group were higher than those in the control group (P<0.05).Conclusion Remimazolam combined with tracheal intubation general anesthesia in elderly patients with hip fracture internal fixation can reduce cognitive function, maintain stable vital signs, with high safety and less adverse reactions, which is worthy of clinical application.

参考文献/References:

[1]Radinovic K,Denic LM,Milan Z,et al.Impact of intraoperative blood pressure, blood pressure fluctuation, and pulse pressure on postoperative delirium in elderly patients with hip fracture:a prospective cohort study[J].Injury,2019,50(9):1558-1564.[2]Ward T,Hussain MM,Burns A,et al.Arthroscopic Femoral and Acetabular Osteoplasties Alter the In Vivo Hip Kinematics of Patients With Femoroacetabular Impingement[J].Arthroscopy,Sports Medicine,and Rehabilitation,2022,4(6):1961-1968.[3]魏滨,徐懋,李民,等.脊椎-硬膜外联合麻醉与腰丛联合坐骨神经阻滞用于老年患者髋部骨折内固定术麻醉效果的比较[J].中华麻醉学杂志,2018,38(2):181-184.[4]陈瑶枝,周盈丰,濮玲菲,等.髋部骨折手术老年患者术后1年死亡风险预测模型的建立与验证[J].中华麻醉学杂志,2021,41(8):933-938.[5]Kaur G,Saikia P,Dey S,et al.Pericapsular nervegroup (PENG) block-a scoping review[J].Ain-Shams Journal of Anesthesiology,2022,14(1):29.[6]徐蕊,崔燕,雷黎明.气管插管全身麻醉对妇科腹腔镜手术患者血流动力学指标、激素及血气状态的影响研究[J].临床和实验医学杂志,2021,20(7):776-779.[7]Sequera-Ramos L,Laverriere EK,Garcia-Marcinkiewicz AG,et al.Sedation versus general anesthesia for tracheal intubation in children with difficult airways: A cohort study from the Pediatric Difficult Intubation Registry[J].Anesthesiology,2022,137(4):418-433.[8]Tung A,Fergusson NA,Ng N,et al.Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis[J].British Journal of Anaesthesia,2020,124(4):480-495.[9]江漩,郑小艳,嵇富海,等.瑞马唑仑联合瑞芬太尼在泌尿外科短小手术中的研究[J].中国药学杂志,2021,56(22):1840-1843.[10]陈瑜.不同剂量瑞马唑仑全麻诱导对老年患者镇静深度及血流动力学的影响[D].苏州:苏州大学,2019.[11]汪康,李胜华,邓英虎,等.SuperPATH入路手术治疗老年髋部骨折早期临床疗效分析[J].国际骨科学杂志,2021,42(3):171-176.[12]Struys MM,De Smet T,Depoorter B,et al.Comparison of plasma compartment versus two methods for effect compartment-controlled target-controlled infusion for propofol[J].The Journal of the American Society of Anesthesiologists,2000,92(2):399-399.[13]Zhu B,Xue F,Zhang C,et al.Ginkgolide B promotes osteoblast differentiation via activation of canonical Wnt signalling and alleviates osteoporosis through a bone anabolic way[J].Journal of Cellular and Molecular Medicine,2019,23(8):5782-5793.[14]徐西通,孟丽,赵林.舒芬太尼对老年髋部骨折患者的麻醉效果及感觉阻滞时间、运动阻滞时间的影响[J].海南医学,2021,32(23):3042-3045.[15]Mitchell SM,Chung AS,Walker JB,et al.Delay in Hip Fracture Surgery Prolongs Postoperative Hospital Length of Stay but Does Not Adversely Affect Outcomes at 30 Days[J].Journal of Orthopaedic Trauma,2018,32(12):629-633.[16]Brox WT,Chan PH,Cafri G,et al.Similar mortalitywith general or regional anesthesia in elderly hip fracturepatients[J].Acta Orthop,2016,87(4):152-157.[17]Kealy J,Murray C,Griffin EW,et al.Acute inflammation alters brain energy metabolism in mice and humans: role in suppressed spontaneous activity, impaired cognition, and delirium[J].Journal of Neuroscience,2020,40(29):5681-5696.[18]谭赞全,郑光明,卢敏婷,等.连续髂筋膜间隙阻滞对老年人髋部骨折术后疼痛及应激反应的影响[J].现代中西医结合杂志,2019,28(8):890-892,897.[19]谯瞧,宋平义,官彬,等.气管插管全身麻醉行腹部手术老年患者肺部感染的危险因素及预测模型构建[J].重庆医学,2022,51(7):1167-1171,1176.[20]李晓明,李俊,李德奎,等.右美托咪定辅助全身麻醉对老年下肢骨折患者镇痛效果及术后认知功能和免疫功能的影响[J].中国医药,2019,14(1):91-95.[21]刘文斌,张继青,黄生辉.甲苯磺酸瑞马唑仑在老年肩部手术的麻醉效果及安全性分析[J].甘肃医药,2021,40(7):602-604.

相似文献/References:

[1]赵淑芳.老年髋部骨折术后下肢深静脉血栓形成的预防及护理干预效果分析[J].医学信息,2018,31(02):172.[doi:10.3969/j.issn.1006-1959.2018.02.067]
　ZHAO Shu-fang.Prevention of Lower Extremity Deep Venous Thrombosis in Aged Patients with Hip Fracture and the Effect of Nursing Intervention[J].Journal of Medical Information,2018,31(19):172.[doi:10.3969/j.issn.1006-1959.2018.02.067]
[2]钱 庆,王 亮,夏书江,等.超声引导下髋关节囊周神经阻滞对老年髋部骨折患者术后睡眠质量的影响[J].医学信息,2022,35(12):149.[doi:10.3969/j.issn.1006-1959.2022.12.036]
　QIAN Qing,WANG Liang,XIA Shu-jiang,et al.Effect of Ultrasound-guided Pericystic Nerve Block on Postoperative Sleep Quality in Elderly Patients with Hip Fracture[J].Journal of Medical Information,2022,35(19):149.[doi:10.3969/j.issn.1006-1959.2022.12.036]
[3]魏 韡,毕义琴.系统化康复护理在老年髋部骨折患者围手术期中的应用[J].医学信息,2019,32(12):185.[doi:10.3969/j.issn.1006-1959.2019.12.063]
　WEI Wei,BI Yi-qin.Application of Systematic Rehabilitation Nursing in Perioperative Period of Elderly Patients with Hip Fracture[J].Journal of Medical Information,2019,32(19):185.[doi:10.3969/j.issn.1006-1959.2019.12.063]
[4]张怡群,崔腾云,刘 婷.康复护理干预对髋部骨折患者康复锻炼依从性与功能恢复的影响[J].医学信息,2022,35(16):181.[doi:10.3969/j.issn.1006-1959.2022.16.046]
　ZHANG Yi-qun,CUI Teng-yun,LIU Ting.Effect of Rehabilitation Nursing Intervention on Rehabilitation Exercise Compliance and Functional Recovery in Patients with Hip Fracture[J].Journal of Medical Information,2022,35(19):181.[doi:10.3969/j.issn.1006-1959.2022.16.046]
[5]阿布都艾尼江·阿不力米提,袁 宏.老年髋部骨折术后功能恢复的影响因素研究[J].医学信息,2020,33(01):39.[doi:10.3969/j.issn.1006-1959.2020.01.014]
　Abuduainijiang·Abulimiti,YUAN Hong.Study on Influencing Factors of Functional Recovery in Elderly Hip Fracture Patients[J].Journal of Medical Information,2020,33(19):39.[doi:10.3969/j.issn.1006-1959.2020.01.014]
[6]刘月星,杨朝昕,万 乾,等.老年髋部骨折术前健侧肢体深静脉血栓形成的危险因素分析[J].医学信息,2020,33(10):108.[doi:10.3969/j.issn.1006-1959.2020.10.028]
　LIU Yue-xing,YANG Zhao-xin,WAN Qian,et al.Analysis of Risk Factors for Deep Venous Thrombosis in the Healthy Limbs of the Elderly before Hip Fracture[J].Journal of Medical Information,2020,33(19):108.[doi:10.3969/j.issn.1006-1959.2020.10.028]
[7]岳洪武,黄德清.骨康胶囊对老年骨质疏松性髋部骨折内固定患者术后恢复、骨代谢及骨密度的影响[J].医学信息,2021,34(24):73.[doi:10.3969/j.issn.1006-1959.2021.24.015]
　YUE Hong-wu,HUANG De-qing.Effects of Gukang Capsule on Postoperative Recovery, Bone Metabolism and Bone Mineral Density in Elderly Patients with Osteoporotic Hip Fracture[J].Journal of Medical Information,2021,34(19):73.[doi:10.3969/j.issn.1006-1959.2021.24.015]
[8]吴铭洲,顾 磊,远理娟,等.老年髋部骨折患者术后谵妄研究现状[J].医学信息,2020,33(17):30.[doi:10.3969/j.issn.1006-1959.2020.17.009]
　WU Ming-zhou,GU Lei,YUAN Li-juan,et al.Research Status of Postoperative Delirium in Elderly Patients with Hip Fracture[J].Journal of Medical Information,2020,33(19):30.[doi:10.3969/j.issn.1006-1959.2020.17.009]
[9]黄伟华,张 杰,丁声双,等.椎管内麻醉与全身麻醉对髋部骨折患者术后谵妄影响的Meta分析[J].医学信息,2022,35(23):50.[doi:10.3969/j.issn.1006-1959.2022.23.008]
　HUANG Wei-hua,ZHANG Jie,DING Sheng-shuang,et al.Meta-analysis of the Effects of Spinal Anesthesia and General Anesthesia on Postoperative Delirium in Patients with Hip Fracture[J].Journal of Medical Information,2022,35(19):50.[doi:10.3969/j.issn.1006-1959.2022.23.008]
[10]马贵芬,程李夏,田镇滔,等.瑞马唑仑与丙泊酚在MECT治疗中的应用效果比较[J].医学信息,2024,37(12):102.[doi:10.3969/j.issn.1006-1959.2024.12.022]
　MA Gui-fen,CHEN Li-xia,TIAN Zhen-tao,et al.Comparison of the Application Effects of Remazolam and Propofol in MECT Treatment[J].Journal of Medical Information,2024,37(19):102.[doi:10.3969/j.issn.1006-1959.2024.12.022]

更新日期/Last Update: 1900-01-01