瑞马唑仑对全身麻醉下经导管主动脉瓣置入术后患者谵妄发生率的影响：一项回顾性探索研究

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瑞马唑仑对全身麻醉下经导管主动脉瓣置入术后患者谵妄发生率的影响：一项回顾性探索研究

贵州医科大学麻醉学与心脏电生理课题组

翻译：文春雷 

编辑：宋雨婷

审校：曹莹

目的

预防经导管主动脉瓣置入术（TAVI）后的谵妄很重要，其与患者预后相关。围手术期使用苯二氮卓类药物是术后谵妄的危险因素；然而，一种新型超短效苯二氮卓类药物—瑞马唑仑，与术后谵妄之间的关系尚不清楚。本研究旨在评估全麻下TAVI期间使用瑞马唑仑是否影响术后谵妄的发生率。

方法

这项单中心回顾性研究纳入了2020年3月至2022年5月期间在全身麻醉下接受经股动脉TAVI（TF-TAVI）治疗的所有成年患者。根据麻醉镇静剂的使用情况，将患者分为瑞马唑仑(R)组和异丙酚(P)组。在R组中，所有患者术后均接受氟马西尼治疗。主要指标是术后3天内谵妄的发生率。采用多元逻辑回归分析方法分析TF-TAVI术后谵妄的相关因素。

结果

98例患者纳入分析（R组，n=40；P组，n=58）。R组术后谵妄的发生率明显低于P组（8%比26%，P =0.032）。多元逻辑回归分析显示，即使在调整了年龄、性别、术前认知功能、卒中病史和TF-TAVI的方式后，瑞马唑仑（比值比0.17，95%可信区间CI 0.04–0.80，P =0.024）与术后谵妄的发生率独立相关。

结论

瑞马唑仑可能有利于TF-TAVI的术后谵妄的减少；然而，其有效性须在广泛的前瞻性研究中得到进一步的评估。

原始文献来源：

Shohei Kaneko ,Takayuki Morimoto, Taiga Ichinomiya,et al.Effect of remimazolam on the incidence of delirium after transcatheter aortic valve implantation under general anesthesia:a retrospective exploratory study.[J].Journal of Anesthesia,2023,37:210–218.

英文原文

Effect of remimazolam on the incidence of delirium after transcatheter aortic valve implantation under general anesthesia: a retrospective exploratory study

Purpose: Delirium after transcatheter aortic valve implantation (TAVI) should be prevented because it is associated with worse patient outcomes. Perioperative administration of benzodiazepines is a risk factor for postoperative delirium; however, the association between remimazolam, a newer ultrashort-acting benzodiazepine for general anesthesia, and postoperative delirium remains unclear. This study aimed to evaluate whether remimazolam administration during TAVI under general anesthesia affected the incidence of postoperative delirium.

Methods: This single-center retrospective study recruited all adult patients who underwent transfemoral TAVI (TF-TAVI) under general anesthesia between March 2020 and May 2022. Patients were divided into the remimazolam (R) and propofol (P) groups according to the sedative used for anesthesia. In the R group, all patients received flumazenil after surgery. The primary endpoint was the incidence of delirium within 3 days after surgery. Factors associated with delirium after TF-TAVI were examined by multiple logistic regression analysis.

Results: Ninety-eight patients were included in the final analysis (R group, n=40; P group, n=58). The incidence of postoperative delirium was significantly lower in the R group than in the P group (8% vs. 26%, p=0.032). Multiple logistic regression analysis revealed that remimazolam (odds ratio 0.17, 95% CI 0.04–0.80, p=0.024) was independently associated with the incidence of postoperative delirium, even after adjustment for age, sex, preoperative cognitive function, history of stroke, and TF-TAVI approach.

Conclusion: Remimazolam may benefit TF-TAVI in terms of postoperative delirium; however, its usefulness must be further evaluated in extensive prospective studies.

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免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭

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