Abstract:

Objective　To explore the application effect of remimazolam combined with propofol in manual reduction of hip dislocation in elderly patients under bispectral index (BIS) monitoring. Methods　A total of 75 elderly patients with hip dislocation who underwent manual reduction in Shangluo Traditional Chinese Medicine Hospital from January 2021 to December 2022 were prospectively selected as the study objects. There were 44 males and 31 females, aged 60-85 years, the American Society of Anesthesiologists (ASA) grade was grade I to II, and the body mass index (BMI) was 18.2-25.1 kg/m². The patients were divided into group A (25 cases), group B (25 cases), and group C (25 cases) by the random number table method. All the three groups were given intravenous general anesthesia. Group A was given propofol (intravenous injection), group B was given remimazolam (intravenous injection), and group C was given remimazolam combined with propofol during manual reduction anesthesia (intravenous injection). The anesthetic effect (anesthetic induction time, anesthetic awakening time, anesthetic recovery time, and reduction time), hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)], stress indexes [cortisol (Cor), adrenaline, and neuropeptide Y (NPY)], and adverse reactions (hypotension, bradycardia, respiratory depression, nausea and vomiting, and injection pain) were compared among the 3 groups. Analysis of variance, LSD-t test, χ² test, and Fisher exact probability method were used. Results　There was no statistically significant difference in the reduction time among the three groups (P>0.05). The anesthetic induction time [(62.31±4.15) s], awakening time [(17.26±3.45) min], and recovery time [(6.25±1.56) min] in group C were shorter than those in group A [(68.47±4.56) s, (21.47±4.29) min, and (9.48±1.89) min] and group B [(69.85±4.66) s, (22.36±4.47) min, and (9.24±1.85) min] (all P<0.05); there was no statistically significant difference in the anesthetic induction time, awakening time, or recovery time between group A and group B (all P>0.05). During and after reduction, the levels of MAP [(85.77±4.29) mmHg (1 mmHg=0.133 kPa) and (85.36±4.27) mmHg] and HR [(75.21±3.76) beats/min and (75.68±3.78) beats/min] in group C were lower than those in group A [(89.29±4.46) mmHg, (88.73±4.44) mmHg, (79.24±3.96) beats/min, and (80.15±4.02) beats/min] and group B [(90.21±4.51) mmHg, (89.56±4.47) mmHg, (78.33±3.93) beats/min, and (79.66±3.98) beats/min] (all P<0.05); there was no statistically significant difference in the level of MAP or HR between group A and group B (both P>0.05). After reduction, the levels of Cor [(291.42±32.38) nmol/L], epinephrine [(211.47±14.11) μg/L], and NPY [(118.41±14.81) μg/L] in group C were lower than those in group A [(326.85±36.32) nmol/L, (231.46±15.43) μg/L, and (137.65±17.21) μg/L] and group B [(321.54±34.73) nmol/L, (228.75±15.25) μg/L, and (135.24±16.91) μg/L] (all P<0.05); there was no statistically significant difference in the level of Cor, epinephrine, or NPY between group A and group B (all P>0.05). The total incidence of adverse reactions in group A [56.00% (14/25)] was higher than that in group B [16.00% (4/25)] and group C [12.00% (3/25)] (both P<0.05); there was no statistically significant difference in the total incidence of adverse reactions between group B and group C (P>0.05). Conclusion　Remimazolam combined with propofol for manual reduction anesthesia in elderly patients with hip dislocation under BIS monitoring can effectively improve the anesthetic effect, reduce the respective dosage, promote the analgesia, and is safe.

Key words:

Hip dislocation, Elderly, Manual reduction, Bispectral index, Remimazolam, Propofol, Hemodynamics, Stress response

摘要：

目的　探究脑电双频指数（BIS）监测下瑞马唑仑复合丙泊酚在老年髋关节脱位手法复位中的应用效果。方法　前瞻性选取2021年1月至2022年12月商洛市中医医院收治的75例需行手法复位的老年髋关节脱位患者作为研究对象。男44例，女31例；年龄60～85岁；美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级；体重指数（BMI）18.2～25.1 kg/m²。采用随机数字表法，将患者分为A组（25例）、B组（25例）、C组（25例）。3组均行静脉全身麻醉，A组采用丙泊酚麻醉（静脉注射），B组采用瑞马唑仑麻醉（静脉注射），C组采用瑞马唑仑复合丙泊酚麻醉（静脉注射）。比较3组麻醉效果（麻醉诱导时间、麻醉苏醒时间、麻醉恢复时间、复位时间）、血流动力学指标［平均动脉压（MAP）、心率（HR）］、应激指标［皮质醇（Cor）、肾上腺素、神经肽Y（NPY）］及不良反应（低血压、心动过缓、呼吸抑制、恶心呕吐、注射痛）。采用方差分析、LSD-t检验、χ²检验和Fisher确切概率法。结果　3组复位时间比较，差异无统计学意义（P>0.05）；C组麻醉诱导时间［（62.31±4.15）s］、苏醒时间［（17.26±3.45）min］、恢复时间［（6.25±1.56）min］均短于A组［（68.47±4.56）s、（21.47±4.29）min、（9.48±1.89）min］、B组［（69.85±4.66）s、（22.36±4.47）min、（9.24±1.85）min］（均P<0.05）；A组与B组麻醉诱导时间、苏醒时间、恢复时间比较，差异均无统计学意义（均P>0.05）。复位中、复位后，C组MAP［（85.77±4.29）mmHg（1 mmHg=0.133 kPa）、（85.36±4.27）mmHg］、HR［（75.21±3.76）次/min、（75.68±3.78）次/min］水平均低于A组［（89.29±4.46）mmHg、（88.73±4.44）mmHg、（79.24±3.96）次/min、（80.15±4.02）次/min］、B组［（90.21±4.51）mmHg、（89.56±4.47）mmHg、（78.33±3.93）次/min、（79.66±3.98）次/min］（均P<0.05）；A组与B组MAP、HR水平比较，差异均无统计学意义（均P>0.05）。复位后，C组Cor［（291.42±32.38）nmol/L］、肾上腺素［（211.47±14.11）μg/L］、NPY［（118.41±14.81）μg/L］水平均低于A组［（326.85±36.32）nmol/L、（231.46±15.43）μg/L、（137.65±17.21）μg/L］、B组［（321.54±34.73）nmol/L、（228.75±15.25）μg/L、（135.24±16.91）μg/L］（均P<0.05）；A组与B组Cor、肾上腺素、NPY水平比较，差异均无统计学意义（均P>0.05）。A组不良反应总发生率［56.00%（14/25）］高于B组［16.00%（4/25）］、C组［12.00%（3/25）］（均P<0.05）；B组与C组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　在BIS监测下瑞马唑仑复合丙泊酚用于老年髋关节脱位患者手法复位麻醉，不仅可减少用药剂量，还可增强麻醉效果，促进镇痛，且安全性良好。

关键词:

髋关节脱位, 老年, 手法复位, 脑电双频指数, 瑞马唑仑, 丙泊酚, 血流动力学, 应激反应