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| 咪达唑仑对术前中重度焦虑老年患者结直肠癌根治术后谵妄的影响 |
| Effect of midazolam on postoperative delirium in elderly patients with preoperative moderate-severe anxiety undergoing radical resection of colorectal cancer |
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| DOI：10.12089/jca.2024.01.009 |
| 中文关键词: 术后谵妄 老年 术前焦虑 结直肠癌根治术 咪达唑仑 |
| 英文关键词: Postoperative delirium Aged Preoperative anxiety Radical resection of colorectal cancer Midazolam |
| 基金项目:河北省自然科学基金（H2020107010）；秦皇岛市重点研发计划科技支撑项目（202101A186） |
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| 中文摘要: |
目的：探讨术前短期口服咪达唑仑对术前合并中重度焦虑老年患者结直肠癌根治术后谵妄的影响。
方法：选择择期行腹腔镜结直肠癌根治术的老年患者80例，男32例，女48例，年龄65～79岁，BMI 21～27 kg/m2，ASA Ⅱ或Ⅲ级，入院时状态特质焦虑量表（STAI-S）评分≥38分。采用随机数字表法将患者分为两组：对照组和咪达唑仑组，每组40例。咪达唑仑组予咪达唑仑7.5 mg每晚一次，连续服药3～4 d，直到术前1 d；对照组予外观相似的安慰剂半片。记录术前1 d STAI-S评分与术后3 d内谵妄的发生情况，记录入室时、麻醉诱导后30 min、1、2 h、拔管后30 min HR和MAP，记录术中丙泊酚、瑞芬太尼、右美托咪定用量及间羟胺使用情况，记录拔管后30 min、术后24、72 h视觉模拟评分（VAS）、曲马多使用情况以及拔管时间。
结果：与对照组比较，咪达唑仑组术前1 d STAI-S评分、术后谵妄发生率、术中间羟胺使用率、拔管后30 min、术后24 h VAS疼痛评分、曲马多使用率明显降低（P<0.05）。两组术中丙泊酚、瑞芬太尼、右美托咪定用量和拔管时间差异无统计学意义。
结论：术前口服咪达唑仑可有效降低合并术前中重度焦虑老年患者结直肠癌根治术后谵妄的发生。 |
| 英文摘要: |
Objective: To investigate the effect of preoperative oral midazolam on postoperative delirium in elderly patients with preoperative moderate-severe anxiety undergoing radical resection of colorectal cancer.
Methods: Eighty elderly patients undergoing laparoscopic surgery for radical resection of colorectal cancer, 32 males and 48 females, aged 65-79 years, BMI 21-27 kg/m2, ASA physical status Ⅱ or Ⅲ, the state-trait anxiety inventory (STAI-S) ≥ 38 scores at admission were selected. Patients were divided into two groups using random number method: control group and midazolam group, 40 patients in each group. The midazolam group were administrated midazolam 7.5 mg per night till one day before surgery, while the placebo was administrated in the control group. The incidence of delirium 3 days after surgery and the STAI-S scores of one day before surgery were evaluated. The HR and MAP at entry, 30 minutes after anesthesia induction, 1 hour, 2 hours after anesthesia induction, and 30 minutes after extubation were recorded. The total dose of propofol, remifentanil and dexmedetomidine and the using rate of metaraminol were recorded. The visual analog scale scores 30 minutes after extubation, 24 and 72 hours after surgery, the using rate of tramadol, and the extubation time were recorded.
Results: Compared with the control group, the STAI-S scores of one day before surgery, and the incidence of postoperative delirium, the rate of using metaraminol, the VAS scores 30 minutes after extubation and 24 hours after surgery, the rate using of tramadol were significantly decreased in the midazolam group (P < 0.05). There were no significant differences in total dose of propofol, remifentanil, and dexmedetomidine, extubation time between the two groups.
Conclusion: Preoperative oral midazolam can effectively reduce the incidence of postoperative delirium in elderly patients with preoperative moderate-severe anxiety undergoing radical resection of colorectal cancer. |
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