瑞马唑仑对老年患者髋部手术中脑氧饱和度及术后谵妄的影响

孟 慧, 张 庆
安徽医科大学附属合肥医院/合肥市第二人民医院 麻醉科/安徽医科大学第五临床医学院

摘要


目的：观察瑞马唑仑对老年患者髋部手术中脑氧饱和度（Cerebral oxygen saturation,rSO2)及术后谵妄(Postoperative delirium，POD) 的影响。方法：针对全麻进行髋关节手术的老年病人，随机挑选了80名进行研究，将其一分为二，形成瑞马唑仑实验组（简称R组)和丙泊酚对照组（简称P组)，两组各包含40名病患。在进行麻醉初期，R组和P组分别通过静脉给药，各自注入0.3至0.4毫克/千克的瑞马唑仑或1.5至2毫克/千克的丙泊酚。而在麻醉的保持阶段，两组分别以静脉输液泵的方式持续使用瑞马唑仑（0.3至1毫克/千克/小时)和丙泊酚（4至12毫克/千克/小时)。搜集并记载不同小组病患进入手术室（T1)、完成气管插管（T2)、手术初始（T3)、手术后30分钟（T4)、手术后60分钟（T5)及术毕（T6)各时点下的脑组织氧饱和度rSO2、心跳频率（HR)、和平均动脉血压（MAP)数值。同時也记录手术全程时间、摘除气管插管所需时长、患者苏醒时的不安状态、术后疼痛感、恶心与呕吐的发生状况，以及术后谵妄（Postoperative delirium，POD)的出现。结果：R组T3、T4、T5、T6时刻rSO2高于P组，T2、T3、T4、T5时刻MAP高于P组，T3时刻平均HR高于P组（p＜0.05)，围术期R组患者POD、注射痛、低血压发生率低于P组（p＜0.05)。结论：与丙泊酚相比，瑞马唑仑用于老年患者髋部手术的全身麻醉诱导与维持时可显著改善患者术中rSO2，减少血流动力学波动，有利于降低POD的发生率。

关键词


脑氧饱和度；瑞马唑仑；老年人；髋部手术；术后谵妄

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参考


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