瑞马唑仑与丙泊酚麻醉对胸腔镜手术的老年肺癌患者术后谵妄的影响

doi:10.3969/j.issn.1006-5725.2025.19.020

Abstract

Abstract:

Objective To evaluate the effect of remimazolam on the incidence of postoperative delirium （POD） in elderly lung cancer patients undergoing thoracoscopic surgery. Methods A total of 114 elderly patients who underwent unilateral thoracoscopic lung surgery at the Affiliated Hospital of Xuzhou Medical University from October 2024 to April 2025 were recruited in this trial. Patients were randomly assigned to remimazolam group （group R） and propofol group （group P）. Anesthesia induction and maintenance were performed with remimazolam and propofol， respectively. In R group， 0.5 mg of flumazenil was intravenously injected at the end of the surgery for specific antagonism. The incidence of delirium and Quality of Recovery-15 （QoR-15） scores on the first and third postoperative days were compared between the two groups. Intraoperative hemodynamic parameters， total opioid dosage， fluid balance， tracheal tube extubation time after surgery， and the incidence of adverse reactions were recorded. Results There were no statistically significant differences between the groups in the incidence of POD or in QoR-15 scores （P > 0.05）. Compared with group P， patients in group R had a shorter extubation time （P < 0.05）， more stable hemodynamics， lower incidences of intra-operative hypotension and bradycardia， and reduced requirement for vasoactive drugs （P < 0.05）. The consumption of rescue analgesics in the post-anesthesia care unit （PACU） was also lower in group R （P < 0.05）. No significant differences were observed between the groups in the amounts of sufentanil and remifentanil administered， fluid balance， bispectral index （BIS） values， or the incidence of nausea and vomiting （P > 0.05）. Conclusion In elderly patients undergoing elective thoracoscopic surgery， remimazolam-based induction and maintenance of anesthesia did not significantly alter the incidence of POD or compromise postoperative recovery quality compared with propofol. However， the remimazolam group required fewer vasoactive agents and exhibited a shorter tracheal extubation time.

Key words: remimazolam, propofol, thoracoscopic surgery, postoperative delirium

CLC Number:

R614.2

Xi CHEN,Beibei YU,Yuge LIU,Wei ZHAO,Ming. YAN. Comparison of the effects of remimazolam and propofol anesthesia on postoperative delirium in elderly patients with lung cancer undergoing thoracoscopic surgery[J]. The Journal of Practical Medicine, 2025, 41(19): 3089-3095.

Figures/Tables 5

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

References 25

[1]	PALANCA B J A， WILDES T S， JU Y S， et al. Electroencephalography and delirium in the postoperative period ［J］. Br J Anaesth， 2017， 119（2）： 294-307. doi:10.1093/bja/aew475 doi: 10.1093/bja/aew475
[2]	ALDECOA C， BETTELLI G， BILOTTA F， et al. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients ［J］. Eur J Anaesthesiol， 2024， 41（2）： 81-108. doi:10.1097/eja.0000000000001876 doi: 10.1097/eja.0000000000001876
[3]	ORMSETH C H， LAHUE S C， OLDHAM M A， et al. Predisposing and Precipitating Factors Associated With Delirium： A Systematic Review ［J］. JAMA Netw Open， 2023， 6（1）： e2249950. doi:10.1001/jamanetworkopen.2022.49950 doi: 10.1001/jamanetworkopen.2022.49950
[4]	MASUI K. Remimazolam： Its clinical pharmacology and evolving role in anesthesia and sedation practice ［J］. Curr Opin Anaesthesiol， 2024， 37（4）： 344-351. doi:10.1097/aco.0000000000001384 doi: 10.1097/aco.0000000000001384
[5]	KUDOH A， TAKASE H， TAKAHIRA Y， et al. Postoperative confusion increases in elderly long-term benzodiazepine users ［J］. Anesth Analg， 2004， 99（6）： 1674-1678. doi:10.1016/j.jclinane.2003.03.008 doi: 10.1016/j.jclinane.2003.03.008
[6]	American Geriatrics Society 2019 Updated AGS Beers Criteria^® for Potentially Inappropriate Medication Use in Older Adults ［J］. J Am Geriatr Soc， 2019， 67（4）： 674-694. doi:10.1111/jgs.15767 doi: 10.1111/jgs.15767
[7]	HUGHES C G， BONCYK C S， CULLEY D J， et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Delirium Prevention ［J］. Anesth Analg， 2020， 130（6）： 1572-1590. doi:10.1213/ane.0000000000004641 doi: 10.1213/ane.0000000000004641
[8]	YANG J J， LEI L， QIU D， et al. Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery： A Prospective Randomized Controlled Clinical Trial ［J］. Drug Des Devel Ther， 2023， 17： 143-153. doi:10.2147/dddt.s392569 doi: 10.2147/dddt.s392569
[9]	GROSSI S， CATTONI M， ROTOLO N， et al. Video-assisted thoracoscopic surgery simulation and training： a comprehensive literature review ［J］. BMC Med Educ， 2023， 23（1）： 535. doi:10.1186/s12909-023-04482-z doi: 10.1186/s12909-023-04482-z
[10]	LIU X， YU Y， ZHU S. Inflammatory markers in postoperative delirium （POD） and cognitive dysfunction （POCD）： A meta-analysis of observational studies ［J］. PLoS One， 2018， 13（4）： e0195659. doi:10.1371/journal.pone.0195659 doi: 10.1371/journal.pone.0195659
[11]	QIAO Y， FENG H， ZHAO T， et al. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery： The influence of anesthetic technique， cerebral injury and systemic inflammation ［J］. BMC Anesthesiol， 2015， 15： 154. doi:10.1186/s12871-015-0130-9 doi: 10.1186/s12871-015-0130-9
[12]	旷光华，徐伟，夏瑞. 瑞马唑仑的应用现状及其研究进展［J］. 实用医学杂志， 2022， 38（13）： 1695-1700. doi:10.3969/j.issn.1006-5725.2022.13.025 doi: 10.3969/j.issn.1006-5725.2022.13.025
[13]	LIAO Y Q， MIN J， WU Z X， et al. Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer ［J］. Front Aging Neurosci， 2023， 15： 1123089. doi:10.3389/fnagi.2023.1123089 doi: 10.3389/fnagi.2023.1123089
[14]	SHI M， CHEN J， LIU T， et al. Protective Effects of Remimazolam on Cerebral Ischemia/Reperfusion Injury in Rats by Inhibiting of NLRP3 Inflammasome-Dependent Pyroptosis ［J］. Drug Des Devel Ther， 2022， 16： 413-423. doi:10.2147/dddt.s344240 doi: 10.2147/dddt.s344240
[15]	王静，高煜茹，蔡钱伟，等. 瑞马唑仑通过调节肺泡巨噬细胞极化减轻脂多糖诱导的急性肺损伤［J］. 实用医学杂志， 2023， 39（9）： 1092-1097. doi:10.3969/j.issn.1006-5725.2023.09.005 doi: 10.3969/j.issn.1006-5725.2023.09.005
[16]	LIU T， ZHAO H， ZHAO X， et al. Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer： A Single-Center Prospective Randomized Controlled Study ［J］. Med Sci Monit， 2024， 30： e943784. doi:10.12659/msm.943784 doi: 10.12659/msm.943784
[17]	BEVANS T， DEERING-RICE C， STOCKMANN C， et al. Inhaled Remimazolam Potentiates Inhaled Remifentanil in Rodents ［J］. Anesth Analg， 2017， 124（5）： 1484-1490. doi:10.1213/ane.0000000000002022 doi: 10.1213/ane.0000000000002022
[18]	XIE H， LU F， LIU W， et al. Remimazolam alleviates neuropathic pain via regulating bradykinin receptor B1 and autophagy ［J］. J Pharm Pharmacol， 2021， 73（12）： 1643-1651. doi:10.1093/jpp/rgab080 doi: 10.1093/jpp/rgab080
[19]	BANDSCHAPP O， FILITZ J， IHMSEN H， et al. Analgesic and antihyperalgesic properties of propofol in a human pain model ［J］. Anesthesiology， 2010， 113（2）： 421-428. doi:10.1097/aln.0b013e3181e33ac8 doi: 10.1097/aln.0b013e3181e33ac8
[20]	AKHTAR S M M， FAREED A， ALI M， et al. Efficacy and safety of Ciprofol compared with Propofol during general anesthesia induction： A systematic review and meta-analysis of randomized controlled trials （RCT）［J］. J Clin Anesth， 2024， 94： 111425. doi:10.1016/j.jclinane.2024.111425 doi: 10.1016/j.jclinane.2024.111425
[21]	陈红芽，王惠军，王月，等. 瑞马唑仑与丙泊酚对老年眼底日间手术患者全麻恢复质量的影响［J］. 实用医学杂志， 2024， 40（8）： 1052-1057.
[22]	CHOI J Y， LEE H S， KIM J Y， et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery： A randomized non-inferiority trial ［J］. J Clin Anesth， 2022， 82： 110955. doi:10.1016/j.jclinane.2022.110955 doi: 10.1016/j.jclinane.2022.110955
[23]	GUO J， QIAN Y， ZHANG X， et al. Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients： A prospective， randomized and controlled study ［J］. BMC Anesthesiol， 2022， 22（1）： 180. doi:10.1186/s12871-022-01713-6 doi: 10.1186/s12871-022-01713-6
[24]	MÜHLBERG W， PLATT D. Age-dependent changes of the kidneys： Pharmacological implications ［J］. Gerontology， 1999， 45（5）： 243-253. doi:10.1159/000022097 doi: 10.1159/000022097
[25]	MAHENDER A， CHAVAN S S， SAROA R， et al. Recent advances in geriatric anaesthesia ［J］. Indian J Anaesth， 2023， 67（1）： 152-158. doi:10.4103/ija.ija_1029_22 doi: 10.4103/ija.ija_1029_22

项目	P组（n = 55）	R组（n = 56）	χ²/Z/t值	P值
性别/例			0.502	0.478
男	19	23
女	36	33
年龄［M（P₂₅，P₇₅）］/岁	68（67，72）	69（67，71）	-0.160	0.873
BMI/（kg/m2）	24.0 ± 2.2	23.8 ± 2.7	0.383	0.702
ASA分级/例			2.640	0.267
Ⅰ级	17	18
Ⅱ级	26	32
Ⅲ级	12	6
MMSE评分［M（P₂₅，P₇₅）］/分	27（26，28）	27（26，28）	-0.361	0.718
手术时间/min	89.3 ± 35.2	91.0 ± 37.1	-0.251	0.802
麻醉时间/min	121.5 ± 38.6	123.2 ± 39.6	-0.237	0.813
单肺通气时间/min	85.4 ± 35.3	86.8 ± 36.9	-0.207	0.836
补液量/mL	1 040.0 ± 303.3	968.8 ± 284.9	1.276	0.205
出血量/mL	35.2 ± 14.4	39.5 ± 14.0	-1.609	0.111
尿量/mL	259.1 ± 152.2	242.0 ± 125.3	0.648	0.519
高血压/［例（%）］	30（54.5）	24（42.9）	1.517	0.218
糖尿病/［例（%）］	11（20.0）	9（16.1）	0.290	0.590
冠心病/［例（%）］	9（16.4）	6（10.7）	0.758	0.384
吸烟/［例（%）］	13（23.6）	16（28.6）	0.350	0.554

项目	P组（n = 55）	R组（n = 56）	χ² /t值	P值
POD1的谵妄/［例（%）］	6（10.9）	8（14.3）	0.287	0.592
POD3的谵妄/［例（%）］	2（3.6）	1（1.8）	0.361	0.548
术前的QoR-15评分（x ± s）/分	132.4 ± 3.3	131.9 ± 3.0	0.786	0.433
POD1的QoR-15评分（x ± s）/分	99.65 ± 6.5	99.0 ± 6.0	0.552	0.582
POD3的QoR-15评分（x ± s）/分	115.2 ± 6.2	115.9 ± 5.8	-0.685	0.495

指标	T₀	T₁	T₂	T₃	T₄	T₅	T₆
MAP/mmHg
P组	102.0 ± 10.7	76.2 ± 11.0	89.6 ± 12.3	78.3 ± 9.2	79.5 ± 9.2	80.0 ± 8.5	97.7 ± 11.9
R组	99.8 ± 12.1	80.7 ± 10.9	86.9 ± 11.0	83.6 ± 8.3	83.6 ± 8.3	85.3 ± 9.9	98.3 ± 12.5
t值	1.020	-2.179	1.245	-3.191	-2.166	-3.003	-0.248
P值	0.310	0.032	0.216	0.002	0.033	0.003	0.805
心率/（次/min）
P组	76.3 ± 10.8	70.9 ± 8.3	73.3 ± 14.2	62.0 ± 9.2	60.0 ± 7.4	59.0 ± 8.5	73.0 ± 11.4
R组	77.3 ± 9.0	76.2 ± 10.3	78.3 ± 11.2	68.3 ± 8.9	68.0 ± 9.1	67.0 ± 8.7	78.6 ± 11.0
t值	-0.490	-2.796	-2.043	-3.683	-5.229	-5.618	-2.639
P值	0.625	0.006	0.043	0.000	0.000	0.000	0.010
BIS值
P组	92.9 ± 3.1	52.9 ± 4.4	53.0 ± 3.8	51.5 ± 3.8	51.7 ± 4.1	51.8 ± 4.2	87.9 ± 3.6
R组	92.6 ± 3.3	53.8 ± 3.7	52.6 ± 3.6	52.6 ± 4.1	51.5 ± 4.3	52.1 ± 3.7	87.2 ± 4.8
t值	0.343	-1.188	0.547	-1.386	0.261	-0.551	0.867
P值	0.732	0.238	0.586	0.169	0.794	0.583	0.388

项目	P组（n = 55）	R组（n = 56）	t/Z/χ²值	P值
舒芬太尼（x ± s）/μg	34.6 ± 7.5	33.3 ± 6.3	0.940	0.349
瑞芬太尼（x ± s）/mg	1.8 ± 0.5	1.6 ± 0.4	1.193	0.235
罗库溴铵（x ± s）/mg	109.3 ± 31.9	107.14 ± 30.0	0.384	0.701
去氧肾上腺素［M（P₂₅， P₇₅）］/μg	280（80，400）	22.5（0，240）	-3.804	0.000
术中低血压/［例（%）］	18（32.7）	7（12.5）	6.506	0.001
术中心动过缓/［例（%）］	11（20.0）	4（7.1）	3.925	0.048
术中低氧血症/［例（%）］	5（9.1）	4（7.1）	0.141	0.707

项目	P组（n = 55）	R组（n = 56）	t/Z/χ²值	P值
PACU数据
气管导管拔除时间（x ± s）/min	19.3 ± 6.2	16.2 ± 5.8	2.847	0.005
需要抢救镇痛药/［例（%）］	14（25.5）	5（8.9）	5.342	0.021
恶心呕吐/［例（%）］	4（7.3）	6（10.7）	0.401	0.527
病房数据
需要抢救镇痛药/［例（%）］	5（9.1）	4（7.1）	0.141	0.707
恶心呕吐/［例（%）］	2（3.6）	3（5.4）	0.191	0.662
拔除引流管时间［M（P₂₅，P₇₅）］/min	2（2，3）	2（2，4）	-0.494	0.621
术后住院时间［M（P₂₅，P₇₅）］/d	3（3，4）	3（3，4）	-0.329	0.742
肺部并发症/［例（%）］	1（1.8）	0（0.0）	1.027	0.311

Comparison of the effects of remimazolam and propofol anesthesia on postoperative delirium in elderly patients with lung cancer undergoing thoracoscopic surgery

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 25

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Shengrun GAO,Chen LI,Liang WANG,Kezhong LI,Na LIU,Chengjie GAO,Yun LI. To explore the application value of preoperative plasma total cholesterol level in predicting postoperative delirium in patients with esophageal cancer resection [J]. The Journal of Practical Medicine, 2025, 41(7): 1004-1009.
[2]	Xingwei WU,Jianying WANG,Chengxiao GUO,Ziyi LIU,Chao SUN,Fei. YU. The effect of remimazolam on modulating the ROS/RAGE/NF-κB signaling pathway in LPS-induced microglial inflammation [J]. The Journal of Practical Medicine, 2025, 41(2): 153-161.
[3]	Xi LI,Xueling LIU,Xiangling TAN,Daoqi. ZHU. Optimizing postoperative recovery efficiency through early⁃stage phased pulmonary rehabilitation in thoracoscopic surgery [J]. The Journal of Practical Medicine, 2025, 41(14): 2237-2242.
[4]	Junpeng LIU,Shiya LIU,Zhen ZHANG,Changhong MIAO,Xihua. LU. Effects of remimazolam and sevoflurane anesthesia on intracranial pressure and cerebral oxygenation in patients undergoinglaparoscopicsurgery in trendelenburg position [J]. The Journal of Practical Medicine, 2025, 41(13): 2088-2093.
[5]	Junjie ZHANG,Xiaochun YANG,Zhuoyi LIU,Ruoqiu WU,Ping LI,Qulian GUO,E. WANG. A randomized controlled study of remimazolam tosilate under bispectral index and bypass EtCO2 monitoring in daytime hysteroscopic surgery [J]. The Journal of Practical Medicine, 2024, 40(8): 1047-1051.
[6]	Hongya CHEN,Huijun WANG,Yue WANG,Shaofei SU,Guyan. WANG. Remimazolam versus propofol on quality of recovery after general anesthesia in elders undergoing ocular fundus daytime surgery [J]. The Journal of Practical Medicine, 2024, 40(8): 1052-1057.
[7]	Lili TANG,Yue SUN,Xuesheng LIU,Yao. LU. The gender⁃specific effects on doses of remimazolam and quality of postoperative recovery in patients undergoing ambulatory arthroscopic surgery [J]. The Journal of Practical Medicine, 2024, 40(8): 1063-1068.
[8]	Chunhua HU,Guyan WANG,Huijun WANG,Chunhua XI,Congya ZHANG,Lili. WU. Effect of remimazolam combined with desflurane and flumazenil antagonism for anesthesia during ophthalmic day surgery [J]. The Journal of Practical Medicine, 2024, 40(4): 537-542.
[9]	Jinhui XU,Mailong YUAN,Tao ZHOU,Mingsheng ZHANG,Yaqi. LI. Effects of sevoflurane or propofol anesthesia maintenance on renal function and postoperative cognition in patients undergoing liver transplantation [J]. The Journal of Practical Medicine, 2024, 40(24): 3509-3514.
[10]	Jianqiang ZENG,Zhaoying ZHONG,Lei YUAN,Donglan. PENG. Effects of different doses of dexmedetomidine combined with ropivacaine TPVB under ultrasound guidance on vital signs and stress response of patients undergoing thoracoscopic surgery under general anesthesia [J]. The Journal of Practical Medicine, 2024, 40(24): 3527-3533.
[11]	Minyu TANG,Peng. LIANG. Application and research progress of one-lung ventilation lung collapse technique in thoracic surgery [J]. The Journal of Practical Medicine, 2024, 40(20): 2813-2818.
[12]	Jiaman LIN,Yongxin YE,Shanghang LI,Yunfei. CHAI. Effect of remifentanil fast⁃track anesthesia on enhancing postoperative recovery quality in patients undergoing cardiac valve surgery： a prospective randomized controlled trial [J]. The Journal of Practical Medicine, 2024, 40(14): 1988-1994.
[13]	Di WANG,Jian YANG,Xiang HE. Dexmedetomidine alleviates propofol induced learning and memory impairment in rats at developmental stage by regulating AKAP150 [J]. The Journal of Practical Medicine, 2024, 40(12): 1619-1624.
[14]	Shan′e DUAN,Mingzhu ZHONG,Qingde ZHANG,Xuemei. PENG. Effects of sevoflurane and propofol on perioperative HIF⁃1α levels and postoperative recovery in patients undergoing bariatric surgery [J]. The Journal of Practical Medicine, 2024, 40(11): 1554-1559.
[15]	WANG Jing , GAO Yuru, CAI Qianwei, ZHUA Weiwei, HUANG Xiao, SUN Dakang, WANG Xiaozhi, WANG Tao.. Remimazolam alleviates LPS ⁃ induced acute lung injury by regulating macrophage polarization [J]. The Journal of Practical Medicine, 2023, 39(9): 1092-1097.