Analysis of the influence of remazolam on delirium risk in elderly surgical patients
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摘要:
目的 合理选择麻醉药物是降低老年髋关节置换手术患者术后谵妄发生的关键。新型超短效苯二氮䓬类静脉镇静药物瑞马唑仑具有起效快、恢复迅速、无蓄积等优势，在老年患者中应用潜力巨大。本研究探讨瑞马唑仑对老年髋关节置换手术患者谵妄风险的影响。 方法 纳入2021年7月—2023年5月杭州市临平区第一人民医院100例拟行手术治疗的老年患者为研究对象，采用简单随机化法将患者分为丙泊酚组和瑞马唑仑组，每组50例。丙泊酚组予以丙泊酚麻醉诱导及术中麻醉维持，瑞马唑仑组予以瑞马唑仑麻醉诱导及术中麻醉维持。记录2组患者术中血管活性药物使用情况；比较2组患者术后恢复质量及术后谵妄发生率。 结果 2组患者术中均未使用尼卡地平，但术中多巴胺、去甲肾上腺素、阿托品、麻黄碱用量瑞马唑仑组低于丙泊酚组(P < 0.05)；2组髋关节置换手术患者40项恢复质量评分量表评分比较，差异无统计学意义(Waldχ2=0.887，P=0.346)；丙泊酚组患者麻醉苏醒后即刻、术后1 d及术后3 d谵妄发生率分别为26.00%(13/50)、6.00%(3/50)、2.00%(1/50)，瑞马唑仑组分别为14.00%(7/50)、4.00%(2/50)、4.00%(2/50)，组间比较差异无统计学意义(Waldχ2=1.818，P=0.178)。 结论 瑞马唑仑应用于老年手术患者中可有效降低患者术中血管活性药物使用量，但对患者术后恢复质量及谵妄发生风险的影响与丙泊酚相当。 Abstract:Objective Elderly patients undergoing hip replacement surgery are at high risk of postoperative delirium. The rational selection of anesthetic drugs is crucial to reducing this risk. A new type of ultra-short-acting benzodiazepine intravenous sedative, remazolam, offers advantages such as quick onset, rapid recovery, and no accumulation, making it a great application for elderly patients. This study investigates the effect of remazolam on the risk of postoperative delirium in elderly patients undergoing hip replacement surgery. Methods From July 2021 to May 2023, 100 elderly patients scheduled for surgical treatment at the First People' s Hospital of Linping District, Hangzhou, were included as the research object. Patients were divided into the propofol group and the remazolam group by simple randomization method, with 50 cases in each group. The propofol group was given propofol anesthesia induction and intraoperative anesthesia maintenance, while the remazolam group was given remazolam anesthesia induction and intraoperative anesthesia maintenance. The use of vasoactive drugs in the operation between the two groups was recorded. The quality of postoperative recovery and the incidence of postoperative delirium were compared between the two groups. Results Neither group required nicardipine during surgery. However, the dosage of dopamine, norepinephrine, atropine, and ephedrine during operation in the remazolam group was lower than those in the propofol group (P < 0.05). There was no statistical difference in QoR-40 scores between the two groups on immediately after anesthesia, 1st postoperative day, and 3rd postoperative day (Waldχ2=0.887, P=0.346). The incidence of delirium in the propofol group was 26.00% (13/50)immediately after anesthesia, 6.00% (3/50) on the first postoperative day, and 2.00% (1/50) on the third postoperative day. In the remazolam group, the incidence was 14.00% (7/50), 4.00% (2/50), and 4.00% (2/50), respectively, with no statistical difference between the two groups (Waldχ2=1.818, P=0.178). Conclusion Remazolam effectively reduces the dosage of vasoactive drugs in elderly patients undergoing surgery. However, its effects on postoperative recovery quality and postoperative delirium risk are comparable to those of propofol. -
Key words:
- Hip replacement /
- Old age /
- Surgery /
- Remazolam /
- Delirium
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表 1 2组髋关节置换手术患者一般资料比较
Table 1. Comparison of general data between two groups of patients undergoing hip replacement surgery
组别 例数 年龄
(x±s，岁)性别
(男/女，例)BMI
(x±s)ASA分级[例(%)] 手术时长
(x±s，min)Ⅰ级 Ⅱ级 丙泊酚组 50 68.25±5.74 28/22 25.32±2.68 34(68.00) 16(32.00) 92.81±30.41 瑞马唑仑组 50 70.37±6.11 31/19 26.57±3.61 29(58.00) 21(42.00) 99.87±29.42 统计量 1.788a 0.372b 1.966a 1.073b 1.180a P值 0.077 0.542 0.052 0.300 0.241 注：a为t值，b为χ2值。 
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表 2 2组髋关节置换手术患者术中血管活性药物使用情况比较
Table 2. Comparison of vasoactive drug use during hip replacement surgery between the two groups
组别 例数 多巴胺用量
(x±s, mg)去甲肾上腺素用量
(x±s, μg)阿托品用量
[M(P25, P75), mg]麻黄碱用量
(x±s, mg)丙泊酚组 50 45.34±15.00 636.73±208.31 0.45(0.00，0.75) 10.45±3.43 瑞马唑仑组 50 36.45±12.13 514.56±155.25 0.25(0.00，0.50) 9.01±2.67 统计量 3.259a 3.325a 2.933b 2.343a P值 0.002 0.001 0.004 0.021 注：a为t值，b为Z值。
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表 3 2组髋关节置换手术患者手术前后恢复质量比较(x±s，分)
Table 3. Comparison of recovery quality before and after hip replacement surgery between the two groups(x±s, points)
组别 例数 QoR-40评分 术前1 d 术后1 d 术后3 d 丙泊酚组 50 185.34±8.66 165.62±6.18 170.25±8.89 瑞马唑仑组 50 183.27±7.56 168.44±9.31 173.26±9.97
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表 4 2组髋关节置换手术患者术后3个时间点恢复质量水平的广义估计方程结果
Table 4. Results of generalized estimation equation for recovery quality levels at three time points after hip replacement surgery in two groups
组别 β SE P值 Waldχ2 OR值 95% CI 丙泊酚组 瑞马唑仑组 1.047 1.111 0.346 0.887 3.468 0.424~28.370 术前1 d 术后1 d -16.860 1.038 ＜0.001 263.985 0.898 0.846~0.953 术后3 d -12.110 1.169 ＜0.001 107.282 0.679 0.630~0.732
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表 5 2组髋关节置换手术患者术后不同时间点谵妄发生率比较[例(%)]
Table 5. Comparison of delirium incidence at different time points after hip replacement between the two groups[cases(%)]
组别 例数 麻醉苏醒后即刻 术后1 d 术后3 d 丙泊酚组 50 13(26.00) 3(6.00) 1(2.00) 瑞马唑仑组 50 7(14.00) 2(4.00) 2(4.00)
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表 6 2组髋关节置换手术患者术后三个时间点谵妄发生率的广义估计方程结果
Table 6. Generalized estimation equation results for delirium incidence at three time points after hip replacement in two groups
组别 β SE P值 Waldχ2 OR值 95% CI 丙泊酚组 瑞马唑仑组 -0.040 0.030 0.178 1.818 0.620 0.259~1.486 麻醉苏醒后即刻 术后1 d -0.150 0.048 0.002 9.890 0.208 0.082~0.528 术后3 d -0.170 0.045 ＜0.001 14.371 0.123 0.034~0.449
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