前循环大血管急性闭塞取栓术中镇静应用分析  

Application of sedation in thrombectomy for acute occlusion of large vessels of anterior circulation

作　　者：张雷[1] 袁伟琼 孔祥丽[1] 李军朝[1] 张蓓[1] ZHANG Lei;YUAN Weiqiong;KONG Xiangli;LI Junchao;ZHANG Bei(The First Affiliated Hospital of Xi’an Medical College,Xi’an 710000,China;The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安医学院第一附属医院,陕西西安710000 [2]西安交通大学第二附属医院,陕西西安710004

出　　处：《中国实用神经疾病杂志》2022年第9期1103-1107,共5页Chinese Journal of Practical Nervous Diseases

基　　金：陕西省教育厅基金资助项目(编号:21JK0899)。

摘　　要：目的探讨右美托咪定在前循环大血管急性闭塞取栓中应用的有效性、安全性。方法回顾2018-11—2021-12西安医学院第一附属医院取栓治疗的前循环大血管急性闭塞患者的临床资料,根据手术镇静方式分为清醒镇静组(观察组)和无镇静组(对照组),2组均使用单纯抽吸或支架拉栓治疗,对比分析2组镇静水平、穿刺到血管再通时间、成功再灌注率、取栓一次再通率、症状性颅内出血、出院NIHSS评分、90 d良好预后情况。结果观察组的镇静效果显著优先于对照组[(4.25±0.43)分比(1.41±0.56分)],差异有统计学意义(P<0.05)。观察组穿刺至血管再通用时短暂[(48.53±5.62)min比(61.47±6.94)min],差异有统计学意义(P<0.05)。观察组取栓一次再通率较对照组有显著优势(34.38%比20.59%),差异有统计学意义(P<0.05)。2组再灌注率、症状性颅内出血、出院NIHSS评分、90 d良好预后对比差异均无统计学意义(P>0.05)。结论右美托咪定镇静可减少术中患者烦躁、疼痛,明显缩短手术时间,提高取栓一次再通率,可应用于前循环大血管急性闭塞的取栓治疗。Objective To investigate the efficacy and safety of dexmedetomidine in the thrombectomy of acute macrovascular occlusion of anterior circulation.Methods The clinical data of patients with acute macrovas⁃cular occlusion of anterior circulation who underwent thrombectomy in our hospital from November 2018 to Decem⁃ber 2021 were reviewed.Patients were divided into conscious sedation group(observation group)and no sedation group(control group)according to surgical sedation methods.Both groups were treated with simple aspiration or stent-retriever thrombectomy.The differences in sedation level,time from puncture to vascular recanalization,suc⁃cessful reperfusion rate,recanalization rate after thrombectomy,symptomatic intracranial hemorrhage,NIHSS score after discharge and good 90-day prognosis were compared and analyzed between the two groups.Results The sedative effect in the observation group was significantly higher than that in the control group((4.25±0.43)points vs(1.41±0.56)points),and the difference was statistically significant(P<0.05).In the observation group,the time from puncture to vascular recanalization was short((48.53±5.62)min vs(61.47±6.94)min),and the difference was statistically significant(P<0.05).Recanalization rate after thrombectomy in the observation group was signifi⁃cantly higher than that in the control group(34.38%vs 20.59%),and the difference was statistically significant(P<0.05).There were no significant differences on reperfusion rate,symptomatic intracranial hemorrhage,NIHSS score after discharge and good 90-day prognosis between the two groups(P>0.05).Conclusion Sedation with dexmedetomidine can reduce irritability and pain in patients during operation,shorten the operation time obviously,and improve the recanalization rate after thrombectomy.It can be used for thrombectomy of acute macrovascular occlusion of anterior circulation.

关 键 词：前循环大血管 急性闭塞 大血管闭塞 右美托咪定 取栓术 镇静 

分 类 号：R743[医药卫生—神经病学与精神病学]