右美托咪定联合丙泊酚或依托咪酯对颅内动脉瘤介入术患者围插管期血流动力学的影响  

Effect of dexmedetomidine combined with propofol or etomidate on periintubation hemodynamics in cerebral aneurysm patients

作　　者：魏颖[1] 杨学伟[1] 王志君 谢淑华[1] 耿立成[1] WEI Ying;YANG Xuewei;WANG Zhijun;XIE Shuhua;GENG Licheng(Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院麻醉科,天津300121

出　　处：《广州医药》2024年第9期1043-1048,共6页Guangzhou Medical Journal

基　　金：天津市卫生健康科技项目(ZC20035)。

摘　　要：目的探讨右美托咪定(Dex)分别联合丙泊酚或依托咪酯在颅内动脉瘤介入术中的镇静效果及对患者血流动力学的影响。方法将60例颅内动脉瘤介入术患者按照随机数表法分为A组(Dex+丙泊酚,n=30)、B组(Dex+依托咪酯,n=30)。记录两组不同时间点的平均动脉压(MAP)、心率(HR),比较苏醒期的镇静效果、呛咳程度、拔管时间、苏醒时间、清醒时间及术后不良反应。结果A组患者T1MAP、HR为(84.56±5.13)mmHg、(65.87±5.14)次/分和T2(83.29±5.47)mmHg、(65.87±5.14)次/分均低于B组T1(87.89±3.88)mmHg、(70.22±5.67)次/分和T2(86.71±3.75)mmHg、(69.97±5.87)次/分(t分别为2.836、2.825、3.113、3.391,均P<0.001)。两组苏醒期各项指标和躁动(10.00%vs 0%,P=0.757)、呼吸抑制发生率(3.33%vs 0%,P=0.313)比较差异均无统计学意义(均P>0.05),A组恶心、呕吐发生率(3.33%)较B组(20.00%)更低(χ^(2)=4.043,P=0.044)。结论Dex联合丙泊酚、依托咪酯麻醉在颅内动脉瘤介入术中均可发挥良好安全的麻醉作用,降低患者术后躁动和呼吸抑制的发生率,使用Dex联合依托咪酯在患者围插管期的血流动力学的稳定性效果更好,但在降低患者术后恶心呕吐的风险方面效果较差。Objective To evaluate the sedative effect of dexmedetomidine(Dex)combined with propofol or etomidate during cerebral aneurysm intervention and its effect on patient hemodynamics.Methods A total of 60 cerebral aneurysm patients were randomly divided into two groups:Group A(Dex+propofol,n=30)and Group B(Dex+etomidate,n=30).Mean arterial pressure(MAP)and heart rate(HR)were recorded at different time points in the two groups,and the sedation effect,choking degree,extubation time,waking up time,waking time and postoperative side effects were compared.Results T1 MAP,HR of(84.56±5.13)mmHg,(65.87±5.14)times/min and T2(83.29±5.47)mmHg,(65.87±5.14)times/min in group A were lower than those in group B T1(87.89±3.88)mmHg,(70.22±5.67)times/min and T2(86.71±3.75)mmHg,(69.97±5.87)times/min(t=2.836,2.825,3.113,3.391,all P<0.001).There was no significant difference in the incidence of emergence agitation(10.00%vs 0.00%,P=0.757)and respiratory depression(3.33%vs 0.00%,P=0.313)between the two groups(P>0.05).The incidence of nausea and vomiting in group A(3.33%)was lower than that in group B(20.00%)(χ^(2)=4.043,P=0.044).Conclusions Dex combined with propofol and etomidate anesthesia can have a good and safe anesthesia effect in intracranial aneurysm intervention,and reduce the incidence of postoperative agitation and respiratory depression in patients.Hemodynamic stabilization during the tube phase is more effective,but less effective in reducing the risk of postoperative nausea and vomiting in patients.

关 键 词：颅内动脉瘤 右美托咪定 丙泊酚 依托咪酯 血流动力学 

分 类 号：R614[医药卫生—麻醉学]