右美托咪定在急性缺血性脑卒中患者机械性取栓术中的应用:一项前瞻性随机对照研究  

Clinical application of dexmedetomidine in patients with acute ischemic stroke undergoing mechanical thrombectomy:a prospective randomized controlled study

作　　者：张浩[1] 李明[2] 刘福民[1] 刘长君[1] 张思彦[1] ZHANG Hao;LI Ming;LIU Fumin;LIU Changjun;ZHANG Siyan(Department of Anesthesiology,Yidu Central Hospital,Weifang,Shandong 262500,China;Disinfection Supply Center,Yidu Central Hospital)

机构地区：[1]潍坊市益都中心医院麻醉科,山东潍坊262500 [2]潍坊市益都中心医院消毒供应中心

出　　处：《徐州医科大学学报》2023年第6期425-432,共8页Journal of Xuzhou Medical University

基　　金：潍坊市卫生健康委员会科研项目(WFWSJK-2020-120)。

摘　　要：目的评估对接受机械性取栓术(MT)的急性缺血性脑卒中(AIS)患者围术期输注不同剂量右美托咪定的安全性和有效性。方法选取2020年2月—2021年8月于山东省潍坊市益都中心医院行MT治疗的AIS患者。采用随机数字表将入组患者分为3组:RD1组(右美托咪定初始剂量为0.5μg/kg,10 min泵注完毕,术中维持速度为0.2μg·kg^(-1)·h^(-1))、RD2组(右美托咪定初始剂量为0.5μg/kg,10 min泵注完毕,术中维持速度为0.4μg·kg^(-1)·h^(-1))和R组(以相同速度泵注生理盐水)。观察指标如下:患者术前基线特征,术中血流动力学[入导管室(T0)、气管插管前(T1)、气管插管后即刻(T2)、3 min(T3)、6 min(T4)、9 min(T5)、12 min(T6)、15 min(T7)、30 min(T8)、45 min(T9)],成功再通率(mTICI≥2b),时间指标,麻醉药物和血管活性药物的需求量,术后4、12、24、48 h舒芬太尼消耗量和疼痛强度,镇静水平(LOS)和Bruggrmann舒适度评分(BCS),外科医生满意度评分,症状性脑出血例数,术后30 d脑梗死发生率,出院时和脑卒中后90 d mRS,出院时和脑卒中后90 d死亡率。结果与R组相比,RD1组和RD2组患者的心率在T1-T7时间点均显著降低,平均动脉压在T1-T4时间点显著升高,术中七氟醚、瑞芬太尼消耗量显著增加,麻醉恢复室停留时间显著缩短,阿托品消耗量显著增加,但是乌拉地尔和尼莫地平的消耗量显著降低,同时外科医生满意度评分较高(P<0.05)。3组患者成功再通率(mTICI≥2b)、术后各时间点舒芬太尼消耗量和疼痛强度、LOS和BCS评分、术后30 d脑梗死发生率、出院时和卒中后90 d的mRS评分和死亡率比较,差异无统计学意义(P>0.05)。结论围术期联合应用右美托咪定可以降低AIS患者MT治疗中麻醉药物的消耗量,改善外科医生满意度,同时血流动力学更加平稳,但是患者出院时和卒中后90 d的死亡率和功能预后无明显改善。Objective To evaluate the safety and efficacy of perioperative infusion of different doses of dexmedetomidine in acute ischemic stroke(AIS)patients undergoing mechanical thrombectomy(MT).Methods AIS patients who underwent MT in Yidu Central Hospital from February 2020 to August 2021 were enrolled.According to the random number table method,they were divided into three groups:group RD1(dexmedetomidine was given at the initial dose of 0.5μg/kg within 10 min,and maintained at 0.2μg·kg^(-1)·h^(-1)),group RD2(dexmedetomidine was given at the initial dose of 0.5μg/kg within 10 min,and maintained at 0.4μg·kg^(-1)·h^(-1))and group R(normal saline was given at the same rate).The following indicators were observed:baseline information before surgery,intraoperative hemodynamics before entry into the operating room(T0),before tracheal intubation(T1),immediately after tracheal intubation(T2),and at post-tracheal intubation 3 min(T3),6 min(T4),9 min(T5),12 min(T6),15 min(T7),30 min(T8)and 45 min(T9),as well as the success rate of recanalization(mTICI≥2b),time indicators,the consumption of narcotic and vasoactive agents,the consumption of sufentanil at postoperative 4 h,12 h,24 h and 48 h,pain intensity,level of sedation(LOS)and Bruggrmann comfortable score(BCS),surgeon satisfaction,the number of symptomatic intracranial hemorrhage cases,the incidence of cerebral infarction at postoperative 30 days,and mortalities at discharge and 90 days after stroke.Results Compared with group R,group RD1 and group RD2 showed significantly decreased heart rate at T1-T7,and increases in mean arterial pressure at T1-T4,as well as reduced consumption of sevoflurane and remifentanil during operation,shortened length of postanesthesthesia care unit stay,increased use of atropine and decreased use of urapidil and nimodipine,and improved surgeon satisfaction(P<0.05).There was no statistical difference in the success rate of recanalization(mTICI≥2b),the consumption of sufentanil and pain intensity,LOS and BCS,the incidence of cerebral inf

关 键 词：右美托咪定 机械性取栓术 阿片类药物 急性缺血性脑卒中 安全性 有效性 

分 类 号：R614[医药卫生—麻醉学]