Abstract:

Objective　This study was to evaluate the perioperative effect of remazolam combined with propofol anesthesia in elderly patients with spinal fracture. Methods　A prospective, randomized controlled trial was conducted to select 104 elderly patients with spinal fractures admitted to the First Hospital of Northwestern University from January 2021 to December 2023. They were divided into remazolam combined with propofol group (group R) and propofol group (group P) according to the way of anesthesia, with 52 cases in each group. In group P, there were 25 males and 27 females, aged (72.18±4.14) years, and the number of cervical, thoracic and lumbar fractures were 12, 22 and 18, respectively. In group R, there were 26 males and 26 females, aged (72.37±4.21) years old. The number of cervical, thoracic and lumbar fractures were 11, 25 and 16, respectively. Group P was given propofol anesthesia, and group R was given remifentanil combined with propofol anesthesia. Hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO₂)] and stress levels (epinephrine, cortisol) were monitored and recorded at four time points: upon entry (T0), 5 minutes after anesthesia (T1), 60 minutes after anesthesia (T2), and at the end of the surgery (T3). Pain levels and cognitive function were compared between the two groups preoperatively, 1 day postoperatively, and 3 days postoperatively, as well as the incidence of complications. Statistical analysis was performed using χ² test and t test. Results　(1) At time points T0 to T3, MAP in the P group was (96.23±11.06, 75.38±7.24, 73.35±6.24, 77.42±6.16) mmHg(1 mmHg=0.133 kPa), while in the R group it was (96.74±10.75, 80.34±8.02, 83.24±9.78, 82.34±10.13) mmHg; the HR in the P group were (80.42±9.13, 76.34±9.35, 70.24±10.04, 72.73±8.92) beats/min, and in the R group they were (79.36±9.41, 74.82±7.23, 73.93±7.34, 76.37±9.06) beats/min. Both groups showed a significant decrease in MAP and HR from T1 to T3 compared to T0, with the R group maintaining higher MAP at T1 to T3 and higher heart rates at T2 and T3 than the P group (all P<0.05). There were no statistically significant differences in SpO₂ at different time points between the two groups (all P>0.05).(2) At time points T0 to T3, adrenaline levels in the P group were (12.43±1.63, 18.02±1.45, 18.24±1.44, 14.31±1.12) ng/L, and in the R group they were (12.24±1.84, 15.36±1.38, 15.73±1.27, 13.19±1.33) ng/L; cortisol levels in the P group were (3.26±1.25, 4.62±1.23, 5.78±1.32, 4.31±1.23) nmol/L, and in the R group they were (3.32±1.24, 3.86±0.73, 4.31±1.16, 3.87±0.73) nmol/L. Levels of adrenaline and cortisol significantly increased from T1 to T3 in both groups, with the R group having lower levels of both epinephrine and cortisol at T1 to T3 compared to the P group (all P<0.05). (3) Preoperatively, and on postoperative days 1 and 3, the Visual Analog Scale (VAS) scores in the P group were (5.83±0.93, 3.86±0.74, 2.34±0.58) points, while in the R group they were (5.87±1.01, 2.79±0.82, 1.33±0.45) points; the Mini-Mental State Examination (MMSE) scores in the P group were (27.91±0.42, 28.32±0.46, 28.75±0.63) points, and in the R group they were (27.78±0.45, 28.52±0.51, 29.11±0.45) points. The VAS scores significantly decreased and MMSE scores significantly increased on postoperative days 1 and 3 in both groups, with the R group performing better than the P group (all P<0.05).(4) The total incidence of adverse reactions in the P group was 32.69% (17/52), compared to 26.92% (14/52) in the R group, with no statistically significant difference (χ²=0.414, P=0.520). Conclusion　Remazolam combined with propofol can better maintain hemodynamic stability, reduce stress response, and help improve early postoperative pain and cognitive function recovery in elderly patients with spinal fracture during the perioperative period, and the incidence of complications is not significantly increased. It is a safe and effective anesthesia strategy.

Key words:

Remimazolam, Propofol, Spinal fracture, Hemodynamics, Pain level, Cognitive function

摘要：

目的　本研究旨在评估瑞马唑仑与丙泊酚复合麻醉在脊柱骨折老年患者围手术期的应用效果。方法　采用前瞻性、随机对照试验，选取2021年1月至2023年12月西北大学第一医院收治的脊柱骨折老年患者104例，按麻醉方式分为丙泊酚组（P组）和瑞马唑仑复合丙泊酚组（R组），每组52例。P组男25例、女27例，年龄（72.18±4.14）岁，颈、胸、腰段骨折患者分别为12、22、18例。R组男26例、女26例，年龄（72.37±4.21）岁，颈、胸、腰段骨折患者分别为11、25、16例。P组给予丙泊酚麻醉，R组给予瑞马唑仑复合丙泊酚麻醉。监测并记录两组患者入室时（T0）、麻醉后5 min（T1）、麻醉后60 min（T2）、术毕（T3）时的血流动力学参数［心率、平均动脉压（MAP）、血氧饱和度（SpO₂）］和应激水平（肾上腺素、皮质醇），比较两组患者术前、术后1 d、术后3 d的疼痛程度和认知功能，并比较两组患者并发症发生率。采用χ²检验、t检验进行统计分析。结果　（1）T0～T3时刻，P组MAP分别为（96.23±11.06、75.38±7.24、73.35±6.24、77.42±6.16）mmHg（1 mmHg=0.133 kPa），R组MAP分别为（96.74±10.75、80.34±8.02、83.24±9.78、82.34±10.13）mmHg；P组心率分别为（80.42±9.13、76.34±9.35、70.24±10.04、72.73±8.92）次/min，R组心率分别为（79.36±9.41、74.82±7.23、73.93±7.34、76.37±9.06）次/min；两组T1～T3时刻的MAP、心率均较T0时刻显著下降；且R组T1～T3时刻的MAP和T2、T3时刻的心率均高于P组（均P<0.05）。两组不同时刻SpO₂差异均无统计学意义（均P>0.05）。（2）T0～T3时刻，P组肾上腺素分别为（12.43±1.63、18.02±1.45、18.24±1.44、14.31±1.12）ng/L，R组肾上腺素分别为（12.24±1.84、15.36±1.38、15.73±1.27、13.19±1.33）ng/L；P组皮质醇分别为（3.26±1.25、4.62±1.23、5.78±1.32、4.31±1.23）nmol/L，R组皮质醇分别为（3.32±1.24、3.86±0.73、4.31±1.16、3.87±0.73）nmol/L；两组T1～T3时刻的肾上腺素、皮质醇水平均显著升高，R组T1～T3时刻的肾上腺素、皮质醇水平均低于P组（均P<0.05）。（3）术前和术后1、3 d，P组视觉模拟评分法（VAS）评分分别为（5.83±0.93、3.86±0.74、2.34±0.58）分，R组VAS分别为（5.87±1.01、2.79±0.82、1.33±0.45）分；P组简易精神状态检查量表（MMSE）评分分别为（27.91±0.42、28.32±0.46、28.75±0.63）分，R组MMSE评分分别为（27.78±0.45、28.52±0.51、29.11±0.45）分；术后1、3 d两组患者的VAS评分显著降低、MMSE评分显著升高，且R组均优于P组（均P<0.05）。（4）P组不良反应总发生率为32.69%（17/52），R组为26.92%（14/52），差异无统计学意义（χ²=0.414，P=0.520）。结论　瑞马唑仑复合丙泊酚麻醉应用于脊柱骨折老年患者围手术期，能更好地维持血流动力学稳定，减轻应激反应，并有助于改善术后早期疼痛及恢复认知功能，且不良反应发生率未显著增加，是一种安全有效的麻醉策略。

关键词:

瑞马唑仑, 丙泊酚, 脊柱骨折, 血流动力学, 疼痛程度, 认知功能