关键词: 瑞马唑仑, 甲状腺相关眼病, 眶壁减压术, 谵妄, 应激反应

Abstract: Objective To investigate the effect of remazolam on postoperative delirium,stress response in patients with thyroid-related ophthalmopathy undergoing orbital decompression surgery.Methods A total of 100 patients with thyroid-related ophthalmopathy who were diagnosed in our hospital from January 2021 to December 2021 and underwent orbital wall decompression were selected as the research subjects,and were divided into the intervention group(n=51) and the control group(n=49) according to the random number method.The intervention group received remazolam and propofol anesthesia induction and maintenance during the operation,while the control group received normal saline and propofol anesthesia induction and maintenance during the operation.The incidence of delirium,stress response(epinephrine,norepinephrine,cortisol,blood glucose levels),hemorheology(MAP,HR),adverse reactions and satisfaction were observed and recorded in the two groups of patients at different time points after operation.Results The incidence of delirium in the intervention group within 5 days after surgery(3.92%) was lower than that in the control group(15.67%)(P<0.05),but the incidence of delirium in the intervention group within 7 days after surgery(1.96%) was not statistically different with that in the control group(5.88%)(P>0.05).The epinephrine [(100.52±18.41)ng/ml,(112.20±19.22)ng/ml],norepinephrine [(401.14±30.14)ng/ml,(436.63±32.11)ng/ml],cortisol [(231.29±26.63) ng/ml,(246.25±26.79)ng/ml],blood glucose [(6.33±1.22)mmol/L,(7.15±1.36)mmol/L] levels in the intervention group at 6h and 1d after operation were significantly lower than those in the control group [(120.25±20.22)ng/ml,(135.52±21.63) ng/ml,(452.11±33.20)ng/ml,(560.14±35.16)ng/ml,(286.63±28.52)ng/ml,(310.14±30.10)ng/ml,(7.85±1.52)mmol/L,(8.85±1.89)mmol/L](P<0.05),but the epinephrine,norepinephrine,cortisol  and blood glucose in the two groups at 2d after operation had no significant difference(P>0.05).The rate of postoperative adverse reactions in the intervention group(11.76%) was lower than that in the control group(31.37%)(P<0.05),but there was no statistically significant difference in doctor satisfaction between the two groups(P>0.05).Conclusion  The use of remazolam in orbital wall decompression patients with thyroid-related eye disease does not increase the incidence of postoperative delirium,while reducing stress response and postoperative adverse reactions,and increasing patient and physician satisfaction.

Key words: remazolam, thyroid-related eye disease, orbital wall decompression, delirium, stress response