{"title":"雷马唑仑与咪达唑仑对拔牙老年患者术后早期认知恢复的影响：前瞻性随机对照研究》。","authors":"Bing Liu, Peijuan Wang, Lirong Liang, Wei Zhu, Hui Zhang","doi":"10.2147/DDDT.S491223","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Elderly patients undergoing dental extraction are particularly susceptible to delayed cognitive recovery after sedation. This study aimed to compare the effects of remimazolam and midazolam on early postoperative cognitive recovery in elderly patients undergoing dental extraction.</p><p><strong>Patients and methods: </strong>This was a single-centre randomized controlled study with elderly patients scheduled for receiving dental extraction under sedation of remimazolam (Group R) or midazolam (Group M). The primary outcome was postoperative cognitive recovery, as measured by the Montreal cognitive assessment 5-minute (MoCA 5-minute) 30 min postoperatively (T<sub>30</sub>). Secondary outcomes included MoCA 5-minute score 1 h postoperatively (T<sub>1h</sub>), incidence of post-extraction bleeding, intraoperative adverse events, success rate of sedation, time to discharge, and complications.</p><p><strong>Results: </strong>106 patients (53 in each group) were eligible for the study. At T<sub>30</sub>, MoCA 5-minute score was 25 (IQR 23.5, 27) in Group R, significantly higher than that of 23 (IQR 21, 25) in Group M (P < 0.001). This difference persisted at T<sub>1h</sub> [27 (IQR 26, 28) vs 26 (IQR 25, 27), P = 0.003]. Group R also exhibited better hemostasis, with a lower post-extraction bleeding rate at T<sub>1</sub> (5.67% vs 33.96%, χ<sup>2</sup> = 13.36, P < 0.001). Group R showed significantly shorter times to peak sedation after the first dose of medication, awake time, and time to discharge compared to Group M (P < 0.001, P < 0.001, P < 0.001).</p><p><strong>Conclusion: </strong>Remimazolam sedation significantly improves early postoperative cognitive recovery, leading to expedited hemostasis and a shorter discharge time.</p>","PeriodicalId":11290,"journal":{"name":"Drug Design, Development and Therapy","volume":"18 ","pages":"5895-5904"},"PeriodicalIF":4.7000,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639880/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of Remimazolam vs Midazolam on Early Postoperative Cognitive Recovery in Elderly Patients Undergoing Dental Extraction: A Prospective Randomized Controlled Study.\",\"authors\":\"Bing Liu, Peijuan Wang, Lirong Liang, Wei Zhu, Hui Zhang\",\"doi\":\"10.2147/DDDT.S491223\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Elderly patients undergoing dental extraction are particularly susceptible to delayed cognitive recovery after sedation. This study aimed to compare the effects of remimazolam and midazolam on early postoperative cognitive recovery in elderly patients undergoing dental extraction.</p><p><strong>Patients and methods: </strong>This was a single-centre randomized controlled study with elderly patients scheduled for receiving dental extraction under sedation of remimazolam (Group R) or midazolam (Group M). The primary outcome was postoperative cognitive recovery, as measured by the Montreal cognitive assessment 5-minute (MoCA 5-minute) 30 min postoperatively (T<sub>30</sub>). Secondary outcomes included MoCA 5-minute score 1 h postoperatively (T<sub>1h</sub>), incidence of post-extraction bleeding, intraoperative adverse events, success rate of sedation, time to discharge, and complications.</p><p><strong>Results: </strong>106 patients (53 in each group) were eligible for the study. At T<sub>30</sub>, MoCA 5-minute score was 25 (IQR 23.5, 27) in Group R, significantly higher than that of 23 (IQR 21, 25) in Group M (P < 0.001). This difference persisted at T<sub>1h</sub> [27 (IQR 26, 28) vs 26 (IQR 25, 27), P = 0.003]. Group R also exhibited better hemostasis, with a lower post-extraction bleeding rate at T<sub>1</sub> (5.67% vs 33.96%, χ<sup>2</sup> = 13.36, P < 0.001). Group R showed significantly shorter times to peak sedation after the first dose of medication, awake time, and time to discharge compared to Group M (P < 0.001, P < 0.001, P < 0.001).</p><p><strong>Conclusion: </strong>Remimazolam sedation significantly improves early postoperative cognitive recovery, leading to expedited hemostasis and a shorter discharge time.</p>\",\"PeriodicalId\":11290,\"journal\":{\"name\":\"Drug Design, Development and Therapy\",\"volume\":\"18 \",\"pages\":\"5895-5904\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2024-12-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639880/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Drug Design, Development and Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/DDDT.S491223\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MEDICINAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drug Design, Development and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/DDDT.S491223","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CHEMISTRY, MEDICINAL","Score":null,"Total":0}
引用次数: 0
摘要
目的：老年拔牙患者镇静后认知恢复延迟尤为敏感。本研究旨在比较雷马唑仑和咪达唑仑对老年拔牙患者术后早期认知恢复的影响。患者和方法：这是一项单中心随机对照研究，老年患者计划在雷马唑仑（R组）或咪达唑仑（M组）镇静下接受拔牙。主要结果是术后认知恢复，通过术后5分钟（MoCA 5分钟）30分钟（T30）的蒙特利尔认知评估来测量。次要结局包括术后1h (t1) MoCA 5分钟评分、拔牙后出血发生率、术中不良事件、镇静成功率、出院时间、并发症。结果：106例患者（每组53例）符合研究条件。T30时，R组MoCA 5分钟评分为25分（IQR 23.5, 27分），显著高于M组23分（IQR 21, 25分）（P < 0.001）。这种差异在t1时仍然存在[27 (IQR 26, 28) vs 26 (IQR 25, 27), P = 0.003]。R组止血效果也较好，T1时拔牙后出血率较低（5.67% vs 33.96%, χ2 = 13.36, P < 0.001）。R组患者首次给药后至镇静高峰时间、清醒时间、出院时间均明显短于M组（P < 0.001, P < 0.001, P < 0.001）。结论：雷马唑仑镇静可显著促进术后早期认知恢复，加速止血，缩短出院时间。
Effect of Remimazolam vs Midazolam on Early Postoperative Cognitive Recovery in Elderly Patients Undergoing Dental Extraction: A Prospective Randomized Controlled Study.
Purpose: Elderly patients undergoing dental extraction are particularly susceptible to delayed cognitive recovery after sedation. This study aimed to compare the effects of remimazolam and midazolam on early postoperative cognitive recovery in elderly patients undergoing dental extraction.
Patients and methods: This was a single-centre randomized controlled study with elderly patients scheduled for receiving dental extraction under sedation of remimazolam (Group R) or midazolam (Group M). The primary outcome was postoperative cognitive recovery, as measured by the Montreal cognitive assessment 5-minute (MoCA 5-minute) 30 min postoperatively (T30). Secondary outcomes included MoCA 5-minute score 1 h postoperatively (T1h), incidence of post-extraction bleeding, intraoperative adverse events, success rate of sedation, time to discharge, and complications.
Results: 106 patients (53 in each group) were eligible for the study. At T30, MoCA 5-minute score was 25 (IQR 23.5, 27) in Group R, significantly higher than that of 23 (IQR 21, 25) in Group M (P < 0.001). This difference persisted at T1h [27 (IQR 26, 28) vs 26 (IQR 25, 27), P = 0.003]. Group R also exhibited better hemostasis, with a lower post-extraction bleeding rate at T1 (5.67% vs 33.96%, χ2 = 13.36, P < 0.001). Group R showed significantly shorter times to peak sedation after the first dose of medication, awake time, and time to discharge compared to Group M (P < 0.001, P < 0.001, P < 0.001).
Conclusion: Remimazolam sedation significantly improves early postoperative cognitive recovery, leading to expedited hemostasis and a shorter discharge time.
期刊介绍：
Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications.
The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas.
Specific topics covered by the journal include:
Drug target identification and validation
Phenotypic screening and target deconvolution
Biochemical analyses of drug targets and their pathways
New methods or relevant applications in molecular/drug design and computer-aided drug discovery*
Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes)
Structural or molecular biological studies elucidating molecular recognition processes
Fragment-based drug discovery
Pharmaceutical/red biotechnology
Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products**
Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development
Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing)
Preclinical development studies
Translational animal models
Mechanisms of action and signalling pathways
Toxicology
Gene therapy, cell therapy and immunotherapy
Personalized medicine and pharmacogenomics
Clinical drug evaluation
Patient safety and sustained use of medicines.
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