右美托咪定在主动脉夹层血管内覆膜支架置入术中的应用

摘要

目的：研究右美托咪定用于主动脉夹层（AD）血管内覆膜支架置入术麻醉管理中的效果及安全性。方法选取该院2011年9月至2014年1月经磁共振成像或螺旋CT血管成像确诊为AD的患者42例，随机分为右美托咪定组（D组）和对照组（C组），各21例。两组患者均行血管内覆膜支架置入术，均给予麻醉诱导。在麻醉诱导前及麻醉维持时，C组患者给予生理盐水，且需持续硝普钠控制性降压；D组患者给予右美托咪定，仅在覆膜支架置入时需硝普钠进一步降压。持续监测两组患者心率（HR）、桡动脉压（IBP）、脑电双频指数（BIS）值等指标，记录麻醉恢复时间以及不良反应情况，术后追问患者主观感受并利用视觉模拟评分法（VAS）进行术后疼痛评分。结果两组患者用药后 HR、IBP、BIS值较用药前明显下降，且C组患者术中HR及BIS值高于D组，差异均有统计学意义（P<0.05）。两组患者使用硝普钠剂量比较，差异有统计学意义（P<0.05）。所有患者术中均无疼痛，无知觉，无明显恶心、呕吐发生，但有术后头痛发生。C组患者术后VAS分值、术后头痛发生率高于D组，但D组患者麻醉恢复时间明显长于C组，差异均有统计学意义（P<0.05）。结论右美托咪定应用于AD血管内覆膜支架置入术中，使患者围术期血流动力学稳定，无反跳性心动过速，且具有术后镇痛作用，是AD血管内覆膜支架置入术麻醉管理中一种安全有效的补充。%Objective To study the effect and safety of dexmedetomidine in the anesthetic management on endovascular transluminal stent-graft placement in aortic dissection(AD). Methods A total of 42 AD patients received from Sep.2011 to Jan. 2014 were selected and randomly divided into the dexmedetomidine group(group D) and the control group(group C),21 cases in each group. The two groups were conducted endovascular transluminal stent-graft placement under anesthesia induction. The pa-tients in group C were transfused NS with continous sodium nitroprusside for depressiurization before and during anesthesia in-duction while group C with exmedetomidine. The group C was merely given sodium nitroprusside for further depressiurization. It was continuously monitored the HR,IBP,BIS and recorded the anesthesia recovery time as well as the adverse drug reaction. After the operation,it inquired the patients about their feelings,and graded postoperative pain by visual analogue scale(VAS). Results The scores of HR,IBP and BIS of the two groups after taking medicine dropped significantly while the HR and BIS of the group C during the operation were higher than that of the group D (P<0.05). The medicine dosage of the two groups has statistical signif icance(P<0.05). All the patients had no pains,feels,obvious nausea and vomiting but occured headache. The postoperative VAS scores,the occurrence rate of postoperative headache of group C were higher than those of group D,but the anesthesia recovery time of group D was obviously longer than that of group C(P<0.05). Conclusion The application of dexmedetomidine has a bet-ter postoperative analgesia and stable haemodynamics during the perioperative period in the anesthetic management on translumi-nal stent-graft placement in aortic dissection without reboud of tachycardia. It is a safe and effective supplementary approach in the anesthetic management on transluminal stent-graft placement in aortic dissection.