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苯磺酸瑞马唑仑或丙泊酚复合阿芬太尼对老年患者内镜下逆行胰胆管造影术后谵妄及安全性的比较
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Abstract:
目的：比较苯磺酸瑞马唑仑或丙泊酚复合阿芬太尼对老年患者内镜下逆行胰胆管造影术(Endoscopic Retrograde Cholangiopancreatography, ERCP)术后谵妄(Postoperative Delirium, POD)及安全性的影响。方法：选择2023年4月至2024年1月我院行无痛ERCP的70岁以上老年患者90例为研究对象，使用随机数字表法将患者分为瑞马唑仑组(n = 45)和丙泊酚组(n = 45)。瑞马唑仑组患者予以苯磺酸瑞马唑仑复合阿芬太尼麻醉，丙泊酚组患者予以丙泊酚复合阿芬太尼麻醉。主要比较两组患者拔管后30 min、术后1天POD发生率。次要比较两组患者麻醉前、麻醉诱导后1 min (T0)、置镜时(T1)、十二指肠扩张时(T2)、手术结束时(T3)和苏醒时(T4)的心率、平均动脉压(MAP)及麻黄碱、甲氧明、去甲肾上腺素等升压药用量；比较两组患者入睡时间、停药至唤醒所需时间(改良警觉/镇静评分，MOAA/S评分 ≥ 3分)；比较两组患者麻醉相关并发症情况(包括低血压、低氧、注射痛等)。结果：两组患者拔管后30 min、术后1天POD发生率差异无统计学意义(P > 0.05)。T0、T1、T3时，瑞马唑仑组MAP高于丙泊酚组(P < 0.05)；两组患者HR比较差异未见统计学意义(P > 0.05)；瑞马唑仑组麻黄碱、甲氧明、去甲肾上腺素的用量少于丙泊酚组(P < 0.05)；瑞马唑仑组入睡时间明显长于丙泊酚组(P < 0.05)，苏醒时间无差异。瑞马唑仑组低血压和注射痛的发生率低于丙泊酚组(P < 0.05)。结论：苯磺酸瑞马唑仑不增加老年患者ERCP术后谵妄的发生，并且与丙泊酚相比，使用瑞马唑仑麻醉的患者术中血流动力学更平稳，血管活性药使用量更低，是老年患者ERCP手术中镇静较为安全的一种替代选择，但其优势需更进一步研究。
Objective: To compare the effects of remimazolam besylate or propofol combined with alfentanil on postoperative delirium (POD) and safety in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: A total of 90 elderly patients aged over 70 years who underwent painless ERCP in our hospital from April 2023 to January 2024 were selected as the study subjects. Using a random number table, the patients were divided into a remimazolam group (n = 45) and a propofol group (n = 45). The remimazolam group received remimazolam besylate combined with alfentanil for anesthesia, while the propofol group received propofol combined with alfentanil. The primary outcomes were the incidence of POD at 30 minutes after extubation and on postoperative day 1. Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), and the dosage of vasopressors (ephedrine, methoxamine, and norepinephrine) at different time points: before anesthesia (baseline), 1 minute after induction (T0), during endoscope insertion (T1), during duodenal dilation (T2), at the end of surgery (T3), and upon awakening (T4). Additionally, the time to fall asleep, time from drug discontinuation to awakening (modified Observer’s Assessment of Alertness/Sedation [MOAA/S] score ≥ 3), and anesthesia-related complications (including hypotension, hypoxia, injection pain, etc.) were compared between the two groups. Results: There was no statistically significant difference in the incidence of POD at 30 minutes after extubation or on postoperative day 1 between the two groups (P > 0.05). At T0, T1, and T3, the
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