Clinical trial of remimazolam and dexmedetomidine in the treatment of elderly patients undergoing lumbar spine surgery
Objective To compare the clinical efficacy and safety of remimazolam injection and dexmedetomidine injection in the treatment of elderly patients undergoing lumbar surgery.Methods Elderly patients undergoing lumbar surgery were divided into treatment and control groups according to the cohort method.At 10 minutes before anesthesia induction,the control group was given 1.0 µg·kg-1 dexmedetomidine via a microinjection pump,while 0.2 mg·kg-1 remimazolam was injected intravenously in the experimental group.Then after anesthesia induction,the rate of dexmedetomidine in the control group was adjusted to 0.5 μg·kg-1·h-1.The rate of remazolam in the experimental group was adjusted to 0.5 mg·kg-1·h-1.Both groups stopped pumping 1 hour before the end of the operation.The intravenous induction drugs of two groups were sufentanyl+etomidate+rocuronium,and the anesthesia maintenance drugs were propofol+remifentanil.The awakening quality,perioperative hemodynamics,inflammatory indicators and adverse events were compared between two groups.Results Fifty-three patients were enrolled in the treatment group,and 58 patients were enrolled in the control group.The extubation time of treatment and control groups was(6.83±4.53)and(6.86±3.71)min;the consciousness recovery time was(8.62±5.92)and(8.81±5.23)min;postanesthesia care unit stay time was(38.36±6.80)and(39.36±6.27)min,the differences were not statistically significant(all P＞0.05).At 1 h after the start of the surgery,the mean arterial pressure values of treatment and control groups were(71.91±5.15)and(68.88±4.84)mmHg,heart rates were(68.51±5.62)and(61.93±5.88)beat·min-1;at the end of the procedure,the mean arterial pressure values of treatment and control groups were(73.08±5.78)and(70.74±6.25)mmHg,heart rates were(69.49±5.15)and(64.91±7.84)beat·min-1;the differences were statistically significant(all P＜0.05).After extubation,C-reactive protein levels of treatment and control groups were(20.78±2.17)and(21.86±2.63)mg·L-1;tumor necrosis factor-α levels were(64.55±5.96)and(70.55±5.14)pg·mL-1;interleukin-6 levels were(107.79±6.94)and(114.66±6.00)pg·mL-1;there were statistically significant of above indexes between two groups(all P＜0.05).The main adverse events in both groups were delirium,delayed awakening,postoperative hypoxemia and postoperative nausea and vomiting,and there were no significant differences in the incidences of adverse events between two groups(all P＞0.05).Conclusion Compared with dexmedetomidine,rimazzolam does not affect the quality of patients'recovery,with little influence on hemodynamics of elderly patients undergoing lumbar surgery,and reduces the level of inflammation without increasing the incidence of postoperative adverse events.
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