瑞马唑仑：能否预防儿童术后谵妄？

摘要译文

瑞马唑仑预防儿童七氟烷麻醉下扁桃体切除术和腺样体切除术后谵妄：一项随机对照研究

目的：

确定在扁桃体切除术和腺样体切除术结束时使用瑞马唑仑预防七氟醚麻醉下儿童出现谵妄的有效性。

患者和方法：

收集104名年龄3-7岁的患者，他们计划在七氟烷麻醉下进行扁桃体切除术和腺样体切除术。

在手术结束时，患者被随机分配接受瑞马唑仑0.2 mg kg-1（干预组，n=52）或0.9%生理盐水（对照组，n=22）。

主要结局指标是术后谵妄的发生率，定义为儿科麻醉术后谵妄（PAED）评分≥10分。

次要结局指标是PAED峰值评分、出现时间、术后疼痛强度、麻醉复苏室（PACU）住院时间、父母满意度和术后三天的行为改变。

结果：

51例接受瑞马佐仑治疗的患者中有6例（12%）发生了术后谵妄，而50例接受生理盐水治疗的患者当中有22例（44%）发生了谵妄（风险差异32%[95%可信区间，16%-49%]，相对风险0.27[95%置信区间，0.12-0.60]；P<0.001）。

瑞马唑仑组的PAED峰值分数（中位数[四分位数范围]）低于生理盐水组（7[6-8]对9[8-11]，P<0.001）。

同样，与生理盐水组相比，瑞马唑仑组的父母满意度有所提高（9[8-10]对8[7-8]，P<0.001）。

各组之间在术后疼痛评分、PACU住院时间或术后行为改变方面没有差异。

结论：

在接受扁桃体切除术和腺样体切除术的儿童中，术后给予瑞玛唑仑0.2 mg kg-1，与0.9%生理盐水相比，可显著降低七氟醚麻醉后出现谵妄的可能性。

关键词：

术后谵妄；全身麻醉；小儿麻醉；瑞马唑仑。

图1麻醉后护理单元前30分钟的PAED峰值评分和ED发生率。

原文摘要

Remimazolam for the Prevention of Emergence Delirium in Children Following Tonsillectomy and Adenoidectomy Under Sevoflurane Anesthesia: A Randomized Controlled Study

Purpose: To identify the effectiveness of remimazolam at the end of tonsillectomy and adenoidectomy for preventing emergence delirium in children under sevoflurane anesthesia.

Patients and methods: One hundred and four patients aged 3-7 years scheduled for tonsillectomy and adenoidectomy under sevoflurane anesthesia were recruited. Patients were randomly assigned to receive either remimazolam 0.2 mg kg-1 (intervention, n=52) or 0.9% normal saline (control, n=52) at the end of the procedure. The primary outcome was the incidence of emergence delirium, defined as a Pediatric Anesthesia Emergence Delirium (PAED) score ≥10. Secondary outcomes were peak PAED score, emergence time, postoperative pain intensity, length of postanesthesia care unit (PACU) stay, parental satisfaction, and postoperative behavior changes three days postoperatively.

Results: Emergence delirium occurred in 6 of 51 (12%) patients receiving remimazolam versus 22 of 50 (44%) patients receiving saline (risk difference 32% [95% confidence interval, 16% to 49%], relative risk 0.27 [95% confidence interval, 0.12 to 0.60]; P<0.001). The peak PAED scores (median [interquartile range]) were lower in the remimazolam group than in the saline group (7 [6-8] versus 9 [8-11], P<0.001). Likewise, parental satisfaction was improved in the remimazolam group compared with the saline group (9 [8-10] versus 8 [7-8], P<0.001). There was no difference between groups concerning postoperative pain scores, length of PACU stay, or postoperative behavior changes.

Conclusion: In children undergoing tonsillectomy and adenoidectomy, administration of remimazolam 0.2 mg kg-1 at the end of the surgery, compared with 0.9% saline, resulted in a significantly lower likelihood of emergence delirium after sevoflurane anesthesia.

Keywords: emergence delirium; general anesthesia; pediatric anesthesia; remimazolam.

Figure 2 The peak PAED scores and the incidence of ED during the first 30 min in the postanesthesia care unit.

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编辑：MiLu.米鹭

校对：Michel.米萱

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