探讨苯磺酸瑞马唑仑复合舒芬太尼在老年腹腔镜腹股沟疝修补术中的应用效果。

本研究为前瞻性、非随机对照试验。纳入2024年1月至2026年1月，天津医科大学第二医院拟行腹腔镜腹股沟疝修补术的老年患者100例。采用便利抽样法，按入组时间交替分配（奇数入组者为对照组，偶数入组者为试验组）。试验组（n=50）采用苯磺酸瑞马唑仑复合舒芬太尼麻醉方案，对照组（n=50）采用丙泊酚复合舒芬太尼麻醉方案。本研究采用单盲设计。分别于术前及术后24、48 h评估患者的认知功能[蒙特利尔认知评估量表（MoCA）、简易精神状态检查量表（MMSE）]、镇静镇痛效果[Ramsay镇静评分（RSS）、视觉模拟评分法（VAS）评分]、血清应激反应指标[肾上腺素、去甲肾上腺素（NE）、皮质醇]，以及围手术期血流动力学指标[麻醉诱导前5 min（T0）、气管插管后5 min（T1）、建立气腹后5 min（T2）、手术结束拔除气管导管后5 min（T3）的平均动脉压（MAP）、心率]，并记录围手术期麻醉药物使用及并发症发生情况。

与对照组比较，试验组主要结局指标（术后24 h MoCA评分）、次要结局指标术后48 h MoCA及术后24、48 h的MMSE评分均更高；术后24、48 h，试验组RSS、VAS评分均较对照组更优，血清肾上腺素、NE及皮质醇水平均更低，差异均有统计学意义（P<0.05）；试验组T1、T2时MAP、心率较对照组均更稳定（P<0.05）。试验组围手术期丙泊酚总用量明显低于对照组（P<0.001）。2组患者围手术期并发症总发生率比较，差异无统计学意义（χ²=1.084，P=0.298）。

本研究初步提示，苯磺酸瑞马唑仑复合舒芬太尼用于老年腹腔镜腹股沟疝修补术可改善患者术后早期认知功能、镇静镇痛可靠、能维持血流动力学稳定、术后应激反应小，且未增加严重不良事件发生率。但上述结论尚需大样本、多中心随机对照试验进一步验证。

To investigate the effects of remimazolam besylate combined with sufentanil in elderly patients undergoing laparoscopic inguinal hernia repair.

This study is a prospective, non-randomized controlled trial. A total of 100 elderly patients scheduled for laparoscopic inguinal hernia repair at the Second Hospital of Tianjin Medical University from January 2024 to January 2026 were included. Patients were alternately assigned according to the time of enrollment into an experimental group (remimazolam besylate combined with sufentanil, n=50) or a control group (propofol combined with sufentanil, n=50) using convenient sampling (those with odd numbers were assigned to the control group, while those with even numbers were assigned to the experimental group). This study adopted a single blind design. Cognitive function [Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE)], sedation and analgesic effects [Ramsay Sedation Scale (RSS) score, Visual Analogue Scale (VAS) score], and serum stress response indicators [adrenaline, norepinephrine (NE), cortisol] were assessed before surgery, and at 24 hours and 48 hours after surgery. Perioperative hemodynamic parameters [mean arterial pressure (MAP) and heart rate at 5 min before anesthesia induction (T0), 5 min after tracheal intubation (T1), 5 min after pneumoperitoneum establishment (T2), and 5 min after tracheal extubation at the end of surgery (T3)] were recorded. The perioperative consumption of anesthetics and the occurrence of perioperative complications were also recorded.

Compared with the control group, the experimental group exhibited higher scores in the primary outcome indicator (24 h postoperative MoCA score) and secondary outcome indicators (48 hours postoperative MoCA score, as well as 24 and 48 hours postoperative MMSE scores). At 24 and 48 hours after surgery, the experimental group had better RSS and VAS scores, alongside lower serum levels of adrenaline, NE and cortisol; all differences were statistically significant (P<0.05). The MAP and heart rate at T1 and T2 were more stable in the experimental group than in the control group (P<0.05). The total perioperative propofol consumption was significantly lower in the experimental group than that in the control group (P<0.001). There was no statistically significant difference in the overall incidence of perioperative complications between the two groups (χ²=1.084, P=0.298).

This study preliminarily indicates that remimazolam besylate combined with sufentanil in elderly patients undergoing laparoscopic inguinal hernia repair can improve early postoperative cognitive function, offer reliable sedation and analgesia, stabilize hemodynamics and attenuate postoperative stress response, with no elevated risk of serious adverse events. However, further large-sample, multicenter randomized controlled trials are required to confirm these findings.