右美托咪定在经皮腹主动脉覆膜支架腔内隔绝术中的应用效果观察  

Application effect of dexmedetomidine in endovascular isolation with percutaneous abdominal aortic stent-graft

作　　者：姜龙 王辉 刘湘雪 刘禹含 王永平 Jiang Long;Wang Hui;Liu Xiangxue;Liu Yuhan;Wang Yongping(Department of Anesthesiology,Daxing Hospital Affiliated to Capital Medical University,Beijing 102600,China;Department of Thoracic and Vascular Surgery,Daxing Hospital Affiliated to Capital Medical University,Beijing 102600,China)

机构地区：[1]首都医科大学大兴教学医院麻醉科,北京102600 [2]首都医科大学大兴教学医院胸外血管外科,北京102600

出　　处：《血管与腔内血管外科杂志》2022年第5期601-605,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨右美托咪定在行经皮腹主动脉覆膜支架腔内隔绝术中的应用效果。方法收集2019年1月至2021年12月于首都医科大学大兴教学医院接受经皮腹主动脉覆膜支架腔内隔绝术治疗的78例腹主动脉夹层(AAD)患者的临床资料,根据麻醉用药的不同将患者分为常规组(采用丙泊酚+瑞芬太尼进行麻醉)和观察组(采用右美托咪定麻醉),每组39例。比较两组患者麻醉前(T0)、麻醉诱导后(T1)、切皮(T2)、术毕即刻(T3)的血压[收缩压(SBP)、舒张压(DBP)]和HR。比较两组患者的术中麻醉效果(Ramsay评分)和术后苏醒质量[苏醒期躁动风险评分(RS)、睁眼时间、完全清醒时间]。比较两组患者术前、术后24 h血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]和神经标志物[中枢神经特异性蛋白(S100-β)、神经元特异性烯醇化酶(NSE)]水平。比较两组患者术后不良反应发生情况。结果T1、T2、T3时刻,观察组患者的SBP、DBP、HR均高于常规组患者,Ramsay评分均低于常规组患者(P<0.05)。术后,观察组患者的RS评分明显低于常规组患者,睁眼时间、完全清醒时间均明显短于常规组患者(P<0.01)。术后24 h,观察组患者的TNF-α、IL-6、S100-β、NSE水平均明显低于常规组患者(P<0.01)。观察组患者术后不良反应总发生率低于常规组患者(P<0.05)。结论右美托咪定可提高经皮腹主动脉覆膜支架腔内隔绝术患者的麻醉效果,维持患者术中血压、HR更加平稳,发挥一定的神经保护作用,术后苏醒质量更为理想,可减轻血管内操作诱发的术后炎性反应程度,减少麻醉相关不良反应。Objective To investigate the application effect of dexmedetomidine in endovascular isolation with percutaneous abdominal aortic stent-graft.Method Clinical data of 78 abdominal aortic dissection(AAD)patients treated with endovascular isolation with percutaneous abdominal aortic stent-graft for AAD in Daxing Hospital Affiliated to Capital Medical University from January 2019 to December 2021 was collected.The 78 patients were divided into routine group(received propofol+remifentanil anesthesia)and observation group(received dexmedetomidine anesthesia)according to the different anesthetic drugs,with 39 cases in each group.The blood pressure[systolic blood pressure(SBP),diastolic blood pressure(DBP)],heart rate(HR)at different time[before anesthesia(T0),after anesthesia induction(T1),skin incision(T2),time immediately after anesthesia(T3)]were compared.The intraoperative anesthesia effect(Ramsay score)and postoperative recovery quality[risk score(RS)of emergence agitation during recovery,eye opening time,and full awake time]were compared;the level of serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],neural markers[soluble protein-100β(S100-β)and neuron specific enolase(NSE)]before and 24 hours after surgery,and the incidence of postoperative adverse reactions were compared.Result SBP,DBP and HR in observation group were higher than those in routine group at T1,T2 and T3,Ramsay score was lower than that in the routine group at T1,T2 and T3(P<0.05).RS was significantly lower than that in the routine group,eye opening time and full awake time in the observation group were significantly shorter than those in the routine group(P<0.01).The levels of TNF-α,IL-6,S100-βand NSE 24 h after surgery in observation group were significantly lower than those in the routine group(P<0.01).The incidence rate of postoperative adverse reactions in the observation group was lower than that in the routine group(P<0.05).Conclusion Dexmedetomidine can improve anesthesia effect of patients undergoing percut

关 键 词：腹主动脉夹层 腔内隔绝术 右美托咪定 麻醉效果 血压 心率 

分 类 号：R543[医药卫生—心血管疾病]