【作者】 陈瑶；

【导师】 李志坚；

【作者基本信息】 中南大学 ， 临床医学（专业学位）， 2023， 硕士

【摘要】 目的:本研究将瑞马唑仑应用于心脏瓣膜置换术的患者,旨在观察瑞马唑仑对术中脑氧饱和度及术后早期谵妄的影响。方法:从计划行择期体外循环下心脏瓣膜置换术患者中挑选62名受试者,随机分为丙泊酚组(P组)及瑞马唑仑组(R组)。麻醉诱导:P组:静脉注射丙泊酚1.5-2.5mg/kg,舒芬太尼0.5ug/kg、罗库溴铵1mg/kg。R组:静脉注射瑞马唑仑0.1-0.3mg/kg,舒芬太尼0.5ug/kg、罗库溴铵1mg/kg,两组患者术中分别持续使用丙泊酚或者瑞马唑仑。在术中持续监测脑氧饱和度,分别在术后24h、48h、72h由经过训练的研究员使用ICU-CAM、CAM及NRS问卷对患者进行认知功能及疼痛的评估,评估受试者术中脑氧饱和度、术后72h内谵妄的发生率。同时比较两组受试者术中不同时间点MAP、PaCO2、PaO2、术后3d内心肌酶、肝功能、肾功能、机械通气时间、ICU停留时间、住院时间等,对比谵妄与未发生谵妄患者术中术中脑氧饱和度情况。结果:共62名患者接受随机分配,每组患者共31人,其中P组1名患者因为术中脑氧信号不完整而被排除,共18(29.5%)名受试者出现术后谵妄,其中R组8(25.8%)名,P组10(33.3%)名,两组患者术后72h内谵妄发生率差异无统计学差异(P=0.519)。R组脑氧饱和度去饱和时间(P=0.019)及脑氧饱和度AUC低于基线值(P=0.023)明显优于P组,两组患者术中脑氧基线值、Δ脑氧值最小值、最大值及平均值无统计学差异(P>0.05)。两组受试者术中麻醉前、CPB开始、CPB结束及出手术室前的MAP、PaCO2、PaO2及Hct无统计学差异(P<0.05),与未发生谵妄的患者相比,谵妄患者机械通气时间(P=0.017)、ICU停留时间(P=0.001)及住院时间(P=0.013)显著增加,且谵妄患者脑氧饱和度基线值显著低于未发生术后谵妄的患者(P=0.048)。结论:在心脏手术中使用瑞马唑仑镇静时,术后72h内谵妄发生率与术中使用丙泊酚镇静相当。但瑞马唑仑组术中脑氧去饱和情况优于丙泊酚组。同时与未发生术后谵妄的患者相比,谵妄患者术前脑氧饱和度基线值较低,同时可能面临插管时间延长、ICU停留时间及住院时间延长的风险。图3幅,表6个,参考文献59篇更多还原

【Abstract】 Objective:In this study,remimazolam tosylate was applied on patients undergoing heart valve replacement,aiming to observe the effect on intraoperative cerebral oxygen saturation and early postoperative delirium.Methods:Sixty-two subjects were selected from patients undergoing elective cardiopulmonary valve replacement and randomly divided into propofol group(P group)and remimazolam group(R group).Anesthesia induction:Group P:intravenous injection of propofol 1.5-2.5mg/kg,sufentanil 0.5ug/kg,rocuronium lmg/kg.Group R:intravenous injection of remimazolam 0.1-0.3mg/kg,sufentanil 0.5ug/kg,rocuronium lmg/kg,and the two groups continued to use propofol or remimazolam respectively.Cerebral oxygen saturation was continuously monitored intraoperatively,and ICU-CAM,CAM and NRS questionnaire were used to evaluate cognitive function and pain at 24h,48h,and 72h after surgery,Respectively,we compared the intraoperative cerebral oxygen saturation and the incidence of intraoperative delirium postoperatively.At the same time,the cardiac muscle enzymes,liver function,renal function,mechanical ventilation time,ICU stay,and hospital stay time were evaluated between two groups.Results:A total of 62 patients were randomly assigned,31 patients in each group,of which 1 patient in group P was excluded due to poor intraoperative cerebral oxygen signal,and a total of 18(29.5%)subjects developed postoperative delirium,including 8(25.8%)in group R and 10(33.3%)in group P,and there was no significant difference in the incidence of delirium within 72 hours after surgery between two groups(P=0.519).The cerebral oxygen saturation desaturation time(P=0.019)and cerebraloxygen saturation AUC in R group were significantly better than those inthe P group(P=0.023),and there were no significant differences in the baseline of cerebral oxygen,the minimum,maximum and average of Δcerebral oxygen in the two groups(P>0.05).Compared with patients without delirium,the duration of mechanical ventilation(P=0.017),ICU length of stay(P=0.001),and length of hospital stay(P=0.013)were significantly increased in patients with delirium,and the baseline of cerebral oxygen saturation in patients with delirium was significantly lower than that in patients without postoperative delirium(P=0.048).Conclusion:Our trial improves that remimazolam does not increase the incidence of delirium in patients undergoing valve replacement compared with propofol-based general anesthesia,but remimazolam can improve intraoperative cerebral oxygen desaturation.Additionally,patients with delirium have a lower baseline of preoperative cerebral oxygen saturation compared with patients without delirium,and the time of mechanical ventilation,ICU stay and hospital stay may be longer.更多还原