Comparative Study on Postoperative Delirium and Safety Profiles of Remimazolam Besylate or Propofol Combined with Alfentanil in Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

目的：比较苯磺酸瑞马唑仑或丙泊酚复合阿芬太尼对老年患者内镜下逆行胰胆管造影术(Endoscopic Retrograde Cholangiopancreatography, ERCP)术后谵妄(Postoperative Delirium, POD)及安全性的影响。方法：选择2023年4月至2024年1月我院行无痛ERCP的70岁以上老年患者90例为研究对象，使用随机数字表法将患者分为瑞马唑仑组(n = 45)和丙泊酚组(n = 45)。瑞马唑仑组患者予以苯磺酸瑞马唑仑复合阿芬太尼麻醉，丙泊酚组患者予以丙泊酚复合阿芬太尼麻醉。主要比较两组患者拔管后30 min、术后1天POD发生率。次要比较两组患者麻醉前、麻醉诱导后1 min (T0)、置镜时(T1)、十二指肠扩张时(T2)、手术结束时(T3)和苏醒时(T4)的心率、平均动脉压(MAP)及麻黄碱、甲氧明、去甲肾上腺素等升压药用量；比较两组患者入睡时间、停药至唤醒所需时间(改良警觉/镇静评分，MOAA/S评分 ≥ 3分)；比较两组患者麻醉相关并发症情况(包括低血压、低氧、注射痛等)。结果：两组患者拔管后30 min、术后1天POD发生率差异无统计学意义(P > 0.05)。T0、T1、T3时，瑞马唑仑组MAP高于丙泊酚组(P 0.05)；瑞马唑仑组麻黄碱、甲氧明、去甲肾上腺素的用量少于丙泊酚组(P Objective: To compare the effects of remimazolam besylate or propofol combined with alfentanil on postoperative delirium (POD) and safety in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: A total of 90 elderly patients aged over 70 years who underwent painless ERCP in our hospital from April 2023 to January 2024 were selected as the study subjects. Using a random number table, the patients were divided into a remimazolam group (n = 45) and a propofol group (n = 45). The remimazolam group received remimazolam besylate combined with alfentanil for anesthesia, while the propofol group received propofol combined with alfentanil. The primary outcomes were the incidence of POD at 30 minutes after extubation and on postoperative day 1. Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), and the dosage of vasopressors (ephedrine, methoxamine, and norepinephrine) at different time points: before anesthesia (baseline), 1 minute after induction (T0), during endoscope insertion (T1), during duodenal dilation (T2), at the end of surgery (T3), and upon awakening (T4). Additionally, the time to fall asleep, time from drug discontinuation to awakening (modified Observer’s Assessment of Alertness/Sedation [MOAA/S] score ≥ 3), and anesthesia-related complications (including hypotension, hypoxia, injection pain, etc.) were compared between the two groups. Results: There was no statistically significant difference in the incidence of POD at 30 minutes after extubation or on postoperative day 1 between the two groups (P > 0.05). At T0, T1, and T3, the MAP in the remimazolam group was higher than that in the propofol group (P 0.05). The remimazolam group required lower doses of ephedrine, methoxamine, and norepinephrine compared to the propofol group (P < 0.05). The time to fall asleep was significantly longer in the remimazolam group (P < 0.05), but there was no difference in awakening time. The incidence of hypotension and injection pain was lower in the remimazolam group (P < 0.05). Conclusion: Remimazolam besylate does not increase the incidence of POD in elderly ERCP patients. Compared with propofol, remimazolam provides more stable intraoperative hemodynamics and reduces the need for vasopressors.