苯磺酸瑞马唑仑复合舒芬太尼对老年患者腹腔镜腹股沟疝手术后认知功能和炎症因子水平的影响

Impact of remimazolam besylate combined with sufentanil on cognition and inflammatory factor levels in elderly patients undergoing laparoscopic inguinal hernia surgery

摘要:

目的 探讨苯磺酸瑞马唑仑复合舒芬太尼对老年患者腹腔镜腹股沟疝手术后认知功能和炎症因子水平的影响。方法 选择2022年7月－2023年12月该院行腹腔镜腹股沟疝手术的老年患者100例，采用随机数表法分为研究组（n = 50，行苯磺酸瑞马唑仑复合舒芬太尼麻醉）和对照组（n = 50，行丙泊酚复合舒芬太尼麻醉）。比较两组患者平均动脉压（MAP）、心率（HR）、血清应激指标［肾上腺素（AD）、去甲肾上腺素（NE）和皮质醇（Cor）］、血清炎症因子［白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）］、简易智力状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）、视觉模拟评分法（VAS）评分、Ramsay镇静评分和不良反应发生率。结果 两组患者MAP和HR水平有时间、组间和交互效应差异（P < 0.05）。术后24 h，研究组AD、NE、Cor、IL-6和TNF-α水平较对照组低，IL-10水平、MoCA评分和MMSE评分较对照组高，差异均有统计学意义（P < 0.05）。术后12和24 h，研究组VAS评分较对照组低，Ramsay评分较对照组高，差异均有统计学意义（P < 0.05）。研究组舒芬太尼追加量为（7.44±1.35）μg，明显少于对照组的（8.25±1.43）μg，差异有统计学意义（t = 2.91，P = 0.004）。两组患者不良反应发生率比较，差异无统计学意义（P > 0.05）。结论 苯磺酸瑞马唑仑+舒芬太尼用于行腹腔镜腹股沟疝手术的老年患者，可降低炎症因子水平，改善患者术后认知功能，且安全性较高。值得临床推广应用。

Abstract:

Objective To explore the impact of remimazolam besylate combined with sufentanil for postoperative cognitive function and inflammatory factor levels in elderly patients underwent laparoscopic inguinal hernia surgery.Methods 100 elderly patients who underwent laparoscopic inguinal hernia surgery were selected and included from July 2022 to December 2023. Divide into a study group (n = 50, remimazolam besylate combined with sufentanil anesthesia) and a control group (n = 50, propofol combined with sufentanil anesthesia) using a random number table method. Compare the mean arterial pressure (MAP), heart rate (HR), plasma stress indicators [adrenaline (AD), norepinephrine (NE) and cortisol (Cor)], serum inflammatory factors [interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)], the mini mental state examination (MMSE) scale, Montreal cognitive assessment (MoCA) scale, visual analogue scale (VAS), Ramsay sedation scale, and adverse reactions between the two groups.Results There were differences in MAP and HR levels between the two groups in terms of time, inter group, and interaction effects (P < 0.05). At 24 h after surgery, compared with the control group, the study group had lower levels of AD, NE, Cor, IL-6, and TNF-α, higher levels of IL-10, MoCA and MMSE scales, the differences were statistically significant (P < 0.05). At 12 and 24 h after surgery, compared with the control group, the study group had lower VAS and higher Ramsay scales, the differences were statistically significant (P < 0.05). The additional dose of sufentanil in the study group was (7.44 ± 1.35) μg, which was lower than that in the control group (8.25 ± 1.43) μg, with statistical difference (t = 2.91, P = 0.004). There was no difference in the incidence of adverse reactions between the two groups (P > 0.05).Conclusion Remimazolam+sufentanil in elderly patients with laparoscopic inguinal hernia surgery can improve their cognitive function by reducing inflammation and with high safety. It is worthy of clinical application.