右美托咪定联合舒芬太尼麻醉方案在经食道超声心动图右心声学造影诊断卵圆孔未闭中的应用价值研究  

Application value of dexmedetomidine combined with sufentanil in diagnosis of patent foramen ovale by transesophageal echocardiography and right echocardiography

作　　者：王雪 胡培[2] 肖彬[2] 赵祥 郑光美[2] WANG Xue;HU Pei;XIAO Bin;ZHAO Xiang;ZHENG Guangmei(Jinzhou Medical University,Jinzhou,Liaoning 121000,China;Department of Ultrasound,Shiyan People's Hospital Affiliated to Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]锦州医科大学,辽宁锦州121000 [2]湖北医药学院附属十堰市人民医院超声科,湖北十堰442000

出　　处：《中国医学工程》2023年第3期8-13,共6页China Medical Engineering

基　　金：湖北省十堰市科技局引导性科研项目(21Y55,19Y80)。

摘　　要：目的研究右美托咪定联合舒芬太尼麻醉方案在经食道超声心动图(TEE)右心声学造影(c-TEE)诊断卵圆孔未闭(PFO)中的应用价值。方法选择十堰市人民医院因不明原因偏头痛、疑脑卒中就诊,并在超声科行常规经胸超声心动图(c-TTE)初步筛查的存在右向左分流(RLS)的患者194名,收集患者一般资料。前期50名患者采用传统无痛丙泊酚麻醉方案(丙泊酚组)、后期采用右美托咪定+舒芬太尼麻醉方案(改良组),比较两组患者插管反应[血压(BP)、心率(HR)、脉搏血氧饱和度(SpO_(2))等变化]及不良反应发生情况,同时比较两种麻醉方案下的TEE对PFO的诊断效能,包括二维结构清晰显示情况、右向左分流的检出情况及定量诊断。结果改良组插管反应及不良反应(如嗜睡、头晕等)发生率低于丙泊酚组(P<0.05),但每组患者插管前后HR、BP、SpO_(2)比较,差异无统计学意义(P>0.05);改良组TEE二维结构显示清晰度高于丙泊酚组,在解剖学危险因素显示上二者比较,差异有统计学意义(χ^(2)=18.85,P<0.001),但在两层隔结构清晰度显示上比较,差异无统计学意义(χ^(2)=1.12,P=0.291);两组c-TEE诊断PFO-RLS检出率比较,差异有统计学意义(χ^(2)=16.20,P<0.001),且改良组高于丙泊酚组;丙泊酚组c-TTE与c-TEE诊断PFO-RLS检出率比较,差异有统计学意义(χ^(2)=9.89,P<0.001),而改良组比较,差异无统计学意义(χ^(2)=3.03,P=0.082)。结论在右美托咪定联合舒芬太尼麻醉方案下进行c-TEE具有不良反应少、二维结构显示清晰、PFO-RLS检出率高的特点,能够满足临床需要,是目前诊断PFO及分流量较为理想的方式。【Objective】To investigate the application of dexmedetomidine combined with sufentanil anesthesia in the diagnosis of patent foramen ovale(PFO)by contrast-transesophageal echocardiograohy(c-TEE).【Methods】A total of 194 patients with right-left shunt(RLS)admitted to our hospital for migraine or suspected stroke of unknown cause and initially screened by contrast-transthoracic echocardiography(c-TTE)were selected.General data of the patients were collected.Fifty patients received traditional painless propofol anesthesia in the early stage(propofol group)and dexmedetomidine+sufentanil anesthesia in the later stage(modified group).Intubation response(BP,HR,SpO_(2),etc.)and adverse reactions were compared between the two groups.At the same time,the diagnostic efficacy of TEE for patent foramen ovale(PFO)under two anesthesia schemes was compared,including the clear display of two-dimensional structure,the detection of right-to-left shunt and quantitative diagnosis.【Results】The incidence of intubation reaction and adverse reactions(such as drowsiness and dizziness)in the modified group was lower than that in the propofol group(P<0.05),but there were no significant differences in HR,BP and SpO_(2) before and after intubation in each group.There was a significant difference in anatomical risk factors between the two groups(χ^(2)=18.85,P<0.001),but there was no significant difference in the clarity of two-layer structure between the two groups(χ^(2)=1.12,P=0.291).There was significant difference in the detection rate of PFO-RLS in c-TEE diagnosis between the two groups(χ^(2)=16.20,P<0.001),and the improved group was higher than the propofol group.There was significant difference in the detection rate of PFO-RLS in c-TTE diagnosis between the propofol group and c-TEE diagnosis between the propofol group(χ^(2)=9.89,P<0.001).There was no significant difference in the modified group(χ^(2)=3.03,P=0.082).【Conclusion】c-TEE under dexmedetomidine combined with sufentanil anesthesia has the characteristics of few

关 键 词：右美托咪定 舒芬太尼 经食道超声心动图 右心声学造影 右向左分流 卵圆孔未闭 

分 类 号：R541.1[医药卫生—心血管疾病] R445.1[医药卫生—内科学]