| 摘要: |
| ［摘要］ 目的 探讨瑞马唑仑联合神经阻滞对老年全麻腹腔镜结直肠恶性肿瘤手术血流动力学与术后认知功能的影响。方法 招募2023年6月至2024年12月在广西壮族自治区人民医院择期行腹腔镜结直肠恶性肿瘤手术的老年患者120例，采用随机数字表法将其分为单纯全麻组（G组）、全麻联合神经阻滞组（N组）、全麻联合瑞马唑仑组（R组）、全麻联合瑞马唑仑复合神经阻滞组（RN组）。R组与RN组在麻醉诱导前10 min持续泵注瑞马唑仑至手术结束，N组与RN组在麻醉诱导后行双侧腹直肌鞘与腹横肌平面阻滞，四组患者均接受相同的麻醉诱导与麻醉维持方案。记录麻醉诱导前10 min（T0）、气管插管时（T1）、气管插管后5 min（T2）、手术开始后1 h（T3）、手术结束时（T4）的平均动脉压（MAP）和心率（HR）；计算各时间点MAP、HR与T0时间点比较的变化值，记为ΔMAP、ΔHR；比较患者术前1 d、术后3 d、术后7 d的简易精神状态检查量表（MMSE）评分，记录术后认知功能障碍（POCD）和不良反应的发生率。结果 RN组、R组T1、T2的ΔMAP、ΔHR低于G组和N组（P<0.05），RN组T3、T4的ΔMAP、ΔHR低于R组、N组、G组（P<0.05）。术后3 d和术后7 d，R组与RN组的MMSE评分高于G组和N组（P<0.05），四组POCD发生率比较差异无统计学意义（P>0.05）。四组不良反应发生率比较差异无统计学意义（P>0.05）。结论 在全麻下行老年腹腔镜结直肠恶性肿瘤的手术中，在常规麻醉基础上应用瑞马唑仑联合神经阻滞有利于维持术中血流动力学平稳，改善老年患者术后认知功能，且不增加不良反应的发生率，具有较高的安全性。 |
| 关键词: 瑞马唑仑 神经阻滞 血流动力学 术后认知功能障碍 |
| DOI：10.3969/j.issn.1674-3806.2025.09.08 |
| 分类号:R 614 |
| 基金项目:广西自然科学基金项目（编号：2023GXNSFAA026324）；广西卫生健康委自筹经费科研课题（编号：Z-A20240091，Z-A20230020） |
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| Effects of remimazolam combined with nerve block on hemodynamics and postoperative cognitive function in elderly patients undergoing laparoscopic surgery for colorectal malignant tumors under general anesthesia |
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ZHANG Yu, WANG Yonghao, ZHONG Yuling, FANG Haiyan, JIANG Qiuxiang, QU Hanqing, DAI Luming, GONG Zheng
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Department of Anesthesiology, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To explore the effects of remimazolam combined with nerve block on intraoperative hemodynamics and postoperative cognitive function in elderly patients undergoing laparoscopic surgery for colorectal malignant tumors under general anesthesia. Methods A total of 120 elderly patients undergoing elective laparoscopic surgery for colorectal malignant tumors in the People′s Hospital of Guangxi Zhuang Autonomous Region from June 2023 to December 2024 were recruited. The patients were divided into four groups by using random number table method: simple general anesthesia group(group G), general anesthesia combined with nerve block group(group N), general anesthesia combined with remimazolam group(group R), and general anesthesia combined with remimazolam and nerve block group(group RN). In group R and group RN, remimazolam was continuously pumped 10 minutes before anesthesia induction until the end of the operation. In group N and group RN, bilateral rectus sheath block and transversus abdominis plane block were performed after anesthesia induction. All the patients in the four groups received the same anesthesia induction and maintenance regimens. The mean arterial pressure(MAP) and heart rate(HR) were recorded 10 minutes before anesthesia induction(T0), during tracheal intubation(T1), 5 minutes after tracheal intubation(T2), 1 hour after the start of the operation(T3), and at the end of the operation(T4). The changing values of MAP and HR at each time point compared to those at T0 were calculated and were denoted as ΔMAP and ΔHR, respectively. The Mini-Mental State Examination(MMSE) scores of the patients were compared at 1 day before the operation, 3 days after the operation, and 7 days after the operation. The incidence rates of postoperative cognitive dysfunction(POCD) and adverse reactions of the patients were recorded. Results The ΔMAP and ΔHR in group RN and group R were lower than those in group G and group N at the time points of T1 and T2(P<0.05). The ΔMAP and ΔHR in group RN were lower than those in group R, group N and group G at the time points of T3 and T4(P<0.05). The MMSE scores of the patients in group R and group RN were higher than those in group G and group N at 3 days and 7 days after the operation(P<0.05). There was no statistically significant difference in the incidence of POCD of the patients among the four groups(P>0.05). There was no statistical difference in the incidence of adverse reactions of the patients among the four groups(P>0.05). Conclusion In laparoscopic surgery for the elderly patients with colorectal malignant tumors under general anesthesia, the application of remimazolam combined with nerve block on the basis of conventional anesthesia is beneficial for maintaining the patients′ intraoperative hemodynamic stability, improving their postoperative cognitive function, and does not increase the incidence of adverse reactions, thus exhibiting high safety. |
| Key words: Remimazolam Nerve block Hemodynamics Postoperative cognitive dysfunction(POCD) |
