瑞马唑仑与丙泊酚麻醉在老年腰椎手术患者中的应用研究

Objective To compare the effects of remimazolam and propofol anesthesia on hemodynamics during the induction phase and postoperative delirium in elderly patients undergoing lumbar surgery. Methods A total of 120 elderly patients undergoing lumbar spine surgery at our hospital from July 2023 to December 2024 were selected and randomly divided into the propofol group and the remimazolam group, with 60 cases in each group. The propofol group received anesthesia induction with propofol, sufentanil, and rocuronium, while the remimazolam group received anesthesia induction with remimazolam, sufentanil, and rocuronium. Both groups were maintained with propofol and remifentanil during the procedure, with the anesthetic depth monitored via the bispectral index(BIS) ranging from 40 to 60. Mean arterial pressure and heart rate were recorded at three time points: before anesthesia induction(T0), when BIS dropped below 60 after induction(T1), and upon successful endotracheal intubation(T2). Postoperative cognitive function was assessed using the Mini-Mental State Examination(MMSE) and the Confusion Assessment Method(CAM) at 72 hours after surgery. Results No significant differences were observed in heart rate and mean arterial pressure between the two groups at time points T0 and T2(P>0.05). At T1, both heart rate and mean arterial pressure were significantly higher in the remimazolam group compared to the propofol group(P<0.05). The propofol group showed a significantly greater change(delta) in both heart rate and mean arterial pressure between T0 and T1 compared to the remimazolam group(P<0.05). There was no significant difference in the incidence of postoperative delirium between the two groups(P>0.05). Conclusion Compared to propofol, remimazolam for anesthetic induction in elderly lumbar spine surgery leads to more stable hemodynamics during the induction phase and does not increase the incidence of postoperative delirium.