瑞马唑仑在老年人骨科手术麻醉中的应用

Application of Remimazolam in Anesthesia for Elderly Patients Undergoing Orthopedic Surgery

摘要: 随着我国老龄化进程的加快，老年患者在骨科手术中的麻醉管理面临独特挑战。瑞马唑仑(Remimazolam)是一种新型短效苯二氮卓类药物，以其快速起效、代谢独立于肝肾功能及可逆性强等优势，在老年骨科手术麻醉中展现出良好的应用前景。本文综述了瑞马唑仑的药理学特点、代谢机制及其在老年骨科手术中，尤其是腰麻术中程序性镇静的临床应用。研究表明，瑞马唑仑可有效维持血流动力学稳定，降低术后认知功能障碍(POCD)的发生率，并通过氟马西尼(Flumazenil)实现快速逆转，提高麻醉安全性和可控性。然而，其高昂成本和长期安全性仍需进一步研究。未来，优化瑞马唑仑的个体化麻醉策略，将有助于提升老年患者的手术安全性和术后恢复质量。

Abstract: With the acceleration of population aging in China, anesthetic management for elderly patients undergoing orthopedic surgery presents unique challenges. Remimazolam, a novel ultra-short-acting benzodiazepine, has demonstrated promising applications in geriatric orthopedic anesthesia due to its rapid onset, metabolism independent of hepatic and renal function, and strong reversibility. This review summarizes the pharmacological characteristics, metabolic mechanisms, and clinical applications of remimazolam in elderly orthopedic surgeries, particularly in procedural sedation for spinal anesthesia. Studies have shown that remimazolam effectively maintains hemodynamic stability, reduces the incidence of postoperative cognitive dysfunction (POCD), and enhances anesthesia safety and controllability through rapid reversal with flumazenil. However, its high cost and long-term safety require further investigation. In the future, optimizing individualized anesthetic strategies with remimazolam may improve surgical safety and postoperative recovery quality in elderly patients.