To explore the effects of remimazolam combined with general anesthesia on postoperative delirium, serum Aβ-42 amyloid protein (Aβ-42) and Tau protein in elderly patients with hip fracture.

A total of 122 elderly patients undergoing hip replacement in the hospital were enrolled between May 2023 and March 2024. There were 63 males and 59 females, with an age of 73.52±3.77 years. According to random number table method, they were divided into group R (remimazolam group) and group P (propofol group), 61 cases in each group. The mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) before induction (T0), at 1min before intubation (T1), immediately after intubation (T2), at 1min after intubation (T3), 3min after intubation (T4) and 5min after intubation (T5), incidence of postoperative deliriumat 1 d (T6), 2 d (T7) and 3 d (T8) after surgery by follow-up, serum Aβ-42, Tau protein and adverse reactions(nausea and vomiting, injection pain, bradycardia, hypotension) in the two groups were recorded.

Repeated ANOVA showed that there were significant differences in HR between the two groups at T0, T1, T2, T3, T4 and T5 (P<0.05), and there was interaction between group and time point (P<0.05), and differences between the two groups were statistically significant at all time points except T0 (P<0.05). There was no significant difference in HR at different time points in either group (P>0.05). Repeated ANOVA showed that there were significant differences in MAP between the two groups at T0, T1, T2, T3, T4 and T5 (P<0.05), and there was interaction between group and time point (P<0.05), and differences between the two groups were statistically significant at all time points except T0 (P<0.05). There were significant difference in MAP at different time points in both groups (P<0.05). Repeated ANOVA showed that there was no significant difference in BIS between the two groups at T0, T1, T2, T3, T4 and T5 (P>0.05), and there was no interaction between group and time point (P>0.05), and difference between the two groups was not statistically significant at any time point (P>0.05). There were significant differences in BIS at different time points in both groups (P<0.05). At T6, incidence of delirium in group R was lower than that in group P (P<0.05), but there was no significant difference in the incidence of delirium between the two groups at T7 and T8 (P>0.05). Repeated ANOVA showed that there were significant differences in levels of serum Aβ-42 and Tau protein between the two groups before and at 3 d after surgery (P<0.05), and there was interaction between group and time point (P<0.05), and differences between the two groups were statistically significant at 3 d after surgery (P<0.05).There were significant differences in levels of serum Aβ-42 and Tau protein before and at 3 d after surgery in both groups (P>0.05). The incidence of adverse reactions in group R was lower than that in group P (P<0.05).

Remimazolam combined with general anesthesia can effectively alleviate heart rate and blood pressure fluctuation in elderly patients with hip fractureduring anesthesia induction, reduce the incidence of postoperative delirium and adverse anesthesia reactions.