瑞马唑仑复合瑞芬太尼行非插管全身麻醉在下肢深静脉血栓AngioJet机械血栓清除术中的安全性及有效性研究  

Safety and Efficacy of Non-Intubated General Anesthesia with Remimazolam Combined with Remifentanil in AngioJet Mechanical Thrombectomy for Lower Extremity Deep Vein Thrombosis

作　　者：龚洁 焦紫耀[2] 刘中凯[2] 刘瑞金 王超 陈文进[2] GONG Jie;JIAO Ziyao;LIU Zhongkai;LIU Ruijin;WANG Chao;CHEN Wenjin(Postgraduate Training Base,Linyi People’s Hospital,Jinzhou Medical University,Shandong Linyi 276000,China;Dept.of Anesthesiology,Linyi People’s Hospital,Shandong Linyi 276000,China;Dept.of Critical Care Medicine,Linyi People’s Hospital,Shandong Linyi 276000,China;Postgraduate Training Base,the First People’s Hospital of Lianyungang,Jinzhou Medical University,Jiangsu Lianyungang 222000,China)

机构地区：[1]锦州医科大学临沂市人民医院研究生培养基地,山东临沂276000 [2]临沂市人民医院麻醉科,山东临沂276000 [3]临沂市人民医院重症医学科,山东临沂276000 [4]锦州医科大学连云港市第一人民医院研究生培养基地,江苏连云港222000

出　　处：《中国医院用药评价与分析》2024年第9期1085-1089,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2021年山东省医学会舒适化医疗科研项目(No.YXH2021ZX021);山东省卫健医疗管理研究中心助力攀登-医疗科研能力提升项目(No.鲁卫医管研函〔2022〕31号)。

摘　　要：目的:探讨瑞马唑仑复合瑞芬太尼行非插管全身麻醉用于下肢深静脉血栓AngioJet机械血栓清除术的安全性及有效性。方法:纳入2021年10月至2023年10月于临沂市人民医院行下肢深静脉血栓AngioJet机械血栓清除术的患者120例,采用随机数字表法分为非插管全身麻醉组(n=60)与清醒镇静组(n=60)。非插管全身麻醉组患者行瑞马唑仑复合瑞芬太尼非插管全身麻醉,清醒镇静组患者行清醒镇静麻醉。比较两组患者入室(T_(1))、靶血管穿刺(T_(2))、喷洒药物(T_(3))、喷洒药物后15 min(T_(4))、吸栓(T_(5))、手术结束5 min(T_(6))、术后1 h(T_(7))、术后4 h(T_(8))、术后12 h(T_(9))时的血流动力学指标,包括收缩压(SBP)、舒张压(DBP)、心排血量(CO)、外周血管阻力(SVR)、每搏输出量、心率。记录并比较两组患者术中和术后抗高血压药使用情况、血红蛋白尿及不良事件发生情况、靶血管穿刺时间、患者满意度评分及医师满意度评分。结果:(1)T_(1)—T_(9)时,两组患者的SBP、DBP组内比较,差异均有统计学意义(P<0.001)。两组患者的SBP、DBP均在T_(3)时开始升高,T_(9)时恢复正常。非插管全身麻醉组患者在T_(2)—T_(5)时的SBP、DBP较清醒镇静组显著降低,差异均有统计学意义(P<0.001)。(2)T_(1)—T_(6)时,两组患者的SVR、CO组内比较,差异均有统计学意义(P<0.001)。T_(3)—T_(6)时两组患者的SVR逐渐升高,T_(2)—T_(5)时两组患者的CO逐渐降低。在T_(2)—T_(6)各时间点,非插管全身麻醉组患者的SVR较清醒镇静组显著降低,差异均有统计学意义(P<0.05)。在T_(3)—T_(6)各时间点,非插管全身麻醉组患者的CO较清醒镇静组显著提高,差异均有统计学意义(P<0.05)。(3)非插管全身麻醉组的医师满意度评分、患者满意度评分较清醒镇静组显著提高,差异均有统计学意义(P<0.001)。(4)非插管全身麻醉组患者术中抗高血压药使用率、体动发生率、术中严重高OBJECTIVE:To probe into the safety and efficacy of non-intubated general anesthesia with remimazolam combined with remifentanil in AngioJet mechanical thrombectomy for lower extremity deep vein thrombosis.METHODS:Totally 120 patients who underwent AngioJet mechanical thrombectomy for lower extremity deep vein thrombosis in Linyi People’s Hospital from Oct.2021 to Oct.2023 were extracted to be divided into the non-intubated general anesthesia group(n=60)and awake sedation group(n=60)through the random number table method.The non-intubated general anesthesia group received remimazolam combined with remifentanil for non-intubated general anesthesia,while the awake sedation group was given awake sedation anesthesia.Vital signs of two groups of patients,including systolic blood pressure(SBP),diastolic blood pressure(DBP),cardiac output(CO),systemic vascular resistance(SVR),stroke volume and heart rate were compared at at the time of admission(T_(1)),target vessel puncture(T_(2)),drug spraying(T_(3)),15 minutes after drug spraying(T_(4)),thrombus aspiration(T_(5)),and 5 minutes after surgery(T_(6)),1 hour after surgery(T_(7)),4 hours after surgery(T_(8)),and 12 hours after surgery(T_(9)).The use of antihypertensive drugs during and after surgery,occurrence of hematuria and adverse events,target vessel puncture time,patients’satisfaction score,and clinicians’satisfaction score were recorded and compared between two groups.RESULTS:(1)From T_(1) to T_(9),there were statistically significant differences within the SBP and DBP groups between the non-intubated general anesthesia group and awake sedation group(P<0.001).Both groups showed an increase in SBP and DBP at T_(3) and returned to normal at T_(9).The non-intubated general anesthesia group showed a significant decrease in SBP and DBP from T_(2) to T_(5) compared with the awake sedation group,with statistically significant difference(P<0.001).(2)From T_(1) to T_(6),there were statistically significant differences with SVR and CO groups between the non-intubated ge

关 键 词：瑞马唑仑 瑞芬太尼 非插管全身麻醉 下肢深静脉血栓 围手术期高血压 

分 类 号：R971.2[医药卫生—药品]