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| 不同剂量瑞马唑仑在老年患者腰-硬联合麻醉术中镇静效果的比较 |
| Effects of different doses of remimazolam on sedative in elderly patients during combined spinal and epidural anesthesia |
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| DOI：10.12089/jca.2022.03.003 |
| 中文关键词: 瑞马唑仑 老年 腰-硬联合麻醉 镇静 脑电双频指数 |
| 英文关键词: Remimazolam Aged Combined spinal and epidural anesthesia Sedation Bispectral index |
| 基金项目:武汉市卫生健康委科研项目（WX21D09） |
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| 中文摘要: |
目的 比较不同剂量瑞马唑仑对腰-硬联合麻醉（CSEA）下行髋关节置换术老年患者术中镇静效果的影响。
方法 选择2021年1—6月在CSEA下行髋关节置换术的老年患者90例，男52例，女38例，年龄65～84岁，BMI 18～31 kg/m2，ASA Ⅰ—Ⅲ级。随机分为三组：瑞马唑仑2 μg·kg-1·min-1组（R2组）、瑞马唑仑3 μg·kg-1·min-1组（R3组）和瑞马唑仑4 μg·kg-1·min-1组（R4组），每组30例。所有患者在L3-4间隙行CSEA，平面固定在T8后，静注瑞马唑仑0.05 mg/kg，R2组、R3组和R4组分别泵注瑞马唑仑2、3、4 μg·kg-1·min-1。使用BIS和改良警觉镇静评分（MOAA/S）评分对患者进行镇静评估。当给药后15 min患者MOAA/S评分＞4分，给予瑞马唑仑0.05 mg/kg进行补救，直至MOAA/S≤4分。记录阻滞前、平面固定后、镇静后5、15、30、60 min的BIS值和MOAA/S评分。记录镇静起效时间、补救次数、苏醒时间、术中低氧血症、术后恶心呕吐的发生情况和术后1 d患者满意度情况。
结果 镇静后5、15、30、60 min，R2组BIS和MOAA/S评分明显高于R3组和R4组（P＜0.05）。R2组镇静起效时间明显长于R3组和R4组（P＜0.05），补救次数明显多于R3组和R4组（P＜0.05）。R4组苏醒时间明显长于R2组和R3组（P＜0.05）。三组术中低氧血症发生率差异无统计学意义。R4组恶心呕吐发生率明显高于R2组和R3组（P＜0.05），术后1 d患者非常满意率明显低于R2组和R3组（P＜0.05）。
结论 瑞马唑仑可以安全用于CSEA下髋关节置换术老年患者术中镇静，与泵注瑞马唑仑2 和4 μg·kg-1·min-1比较，术中泵注瑞马唑仑3 μg·kg-1·min-1镇静效果更好，不良反应更少。 |
| 英文摘要: |
Objective To compare the effects of different doses of remimazolam in sedative on elderly patients undergoing hip replacement under combined spinal and epidural anesthesia (CSEA).
Methods Ninety elderly patients underwent hip replacement from January to June 2021, including 52 males and 38 females, aged 65-84 years, BMI 18-31 kg/m2, ASA physical status Ⅰ- Ⅲ,were randomly divided into three groups: remazolam 2 μg·kg-1·min-1 group (group R2), remazolam 3 μg·kg-1·min-1 group (group R3) and remazolam 4 μg·kg-1·min-1 group (group R4), with 30 cases in each group. CSEA was performed at L3-4. After block reached T8 level, remimazolam 0.05 mg/kg was injected. In groups R2, R3 and R4, 2, 3 and 4 μg·kg-1·min-1 of remimazolam was continuously infused, respectively. Sedation was assessed using BIS and MOAA/S. BIS value and MOAA/S were recorded before anesthesia, after CSEA and 5, 15, 30, 60 minutes after sedation. When the MOAA/S > 4 after sedation, remimazolam 0.05 mg/kg was administration until the MOAA/S ≤ 4. Meanwhile, onset time of sedation, frequency of adding remimazolam, awakening time, the incidence of hypoxemia, the incidence of nausea and vomiting, and the incidence of patient's satisfaction 1 day after surgery were recorded.
Results The BIS value and MOAA/S 5, 15, 30, and 60 minutes after sedation in group R2 were significantly higher than those in groups R3 and R4 (P < 0.05). The onset time of sedation in group R2 was significantly longer than that in groups R3 and R4 (P < 0.05), and the frequency of adding remimazolam was significantly more than that in groups R3 and R4 (P < 0.05). The awakening time in group R4 was significantly longer than that in groups R2 and R3 (P < 0.05). There was no significant difference in the incidence of hypoxemia among the three groups. The incidence of nausea and vomiting in group R4 was higher than that in groups R2 and R3 (P < 0.05), and the very satisfaction 1 day after surgery in group R4 was lower than that in groups R2 and R3 (P < 0.05).
Conclusion Remimazolam can be used for sedation in elderly patients with hip replacement during CSEA. Remimazolam 0.3 μg·kg-1·min-1 had the better effect than that of 2 μg·kg-1·min-1 and 4 μg·kg-1·min-1. |
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