病人自控镇静在冠状动脉支架术中的应用  

Patient-controlled sedation with propofol and midazolam in percutaneous transluminal coronary angioplasty and stenting

作　　者：杨改生[1] 姜桢[1] 金翔华[1] 潘志浩[1] 

机构地区：[1]复旦大学附属中山医院麻醉科

出　　处：《临床麻醉学杂志》2004年第3期153-155,共3页Journal of Clinical Anesthesiology

基　　金：上海市科学技术发展基金资助 (基金号 :48A)

摘　　要：目的　观察不同药物进行病人自控镇静 (PCS)在施行冠状动脉支架术 (PTCA)中的可行性和安全性。方法　 30例行PTCA的病人 ,随机分为三组 :对照组 (C组 )、丙泊酚组 (P组 )和咪唑安定组 (M组 )。C组在常规局麻下施行冠状动脉造影并行PTCA ;P组、M组在实施局麻之前分别采用Graseby930 0PCA注射泵 ,使用丙泊酚、咪唑安定进行PCS。术中检测ECG、HR、BP、SpO2 、病人镇静程度评分及脑电双频谱指数 (BIS) ,并于术前、术中和术后 3h采静脉血测定血浆儿茶酚胺 [肾上腺素 (NE)、多巴胺 (DA)、去甲肾上腺素 (NE)、皮质醇 (CH)、促肾上腺皮质激素 (ACTH)水平变化 ,术后随访病人镇静满意程度和心血管系统并发症情况。结果　三组病人在性别、年龄、心功能和冠脉病变情况无显著差异。术中BP、HR、SpO2 变化也无显著差异 (P >0 0 5 )。术前血浆儿茶酚胺、CH、ACTH水平无显著差异 (P >0 0 5 ) ,术中P组、M组血浆儿茶酚胺、皮质醇、ACTH水平无显著差异(P >0 0 5 ) ,均明显低于C组 (P <0 0 1) ,术后 3h仍低于C组 (P >0 0 5 )。P组、M组镇静评分明显优于C组 (P <0 0 5 ) ,BIS(丙泊酚 81± 3、咪唑安定 80± 3)低于C组 (97± 6 ,P <0 0 5 )。P组、M组镇静满意程度明显优于C组。三组之间心血管系统并发症无显著差异。Objective To observe the effect of patient-controlled sedation(PCS)with profopol or midazolam during transluminal percutaneous coronary angioplasty(PTCA)and stenting(CS). Methods Thirty patients with coronary heart disease were randomly divided into three groups.PCS was carried out with propofol 0.25 mg/kg bolus at 3-minute intervals in group P,and with midazolam 0.5 mg at 3-minute intervals in group M respectively without loading or continuous dose.Sedation level,BP,HR,SpO 2,BIS,ACTH and catecholamine were monitored in all patients.Results there was no significant change of the hemodynamics in all groups(P>0.05).The sedation level in group P and group M was higher than that in the control group (P<0.05),the level of ACTH and catecholamine in group P and M was lower than that in control group(P<0.05).The change of ACTH and catecholamines was not significantly different between the group P and M.Conclusions Patient-controlled sedation with propofol or midazolam in percutaneous transluminal coronary angioplasty and stenting is safe and can decrease the stress response to the operation.

关 键 词：自控镇静 冠状动脉支架术 PCS PTCA 应激反应 咪唑安定 

分 类 号：R614[医药卫生—麻醉学]