右美托咪定复合舒芬太尼用于主动脉瘤腔内隔绝术患者的麻醉效果观察

Anesthesia Effects of Dexmedetomidine Combined with Sufentanil on Patients with Aortic Aneurysm Undergoing Endovascular Graft Exclusion

目的：观察右美托咪定复合舒芬太尼用于局部麻醉下主动脉瘤腔内隔绝术患者的安全性和有效性。方法：选择某院2011年11月-2013年3月择期主动脉瘤覆膜支架腔内隔绝术患者60例，采用随机数字表将其随机分成曲马多复合氟哌利多组（C组，M：30）和右美托咪定复合舒芬太尼组（D组，n=30），两组均于局部麻醉下行手术。D组于切皮前15min静脉泵注右美托咪定0．5gg／kg（10min匀速给予），之后以0．3～0．7μg/L（kg·h）维持，并在切皮前和支架撑开前静脉注射0．15～0．2gg／kg舒芬太尼；C组于切皮前15min将曲马多100mg、氟哌利多注射液5mg合剂溶于等容积生理盐水，以相同方式给予，并在切皮前和支架撑开前给予等容积生理盐水。监测并记录入室（T0）、开始泵注给药后1min（T1）、5min（T2）、15min（T3）、支架撑开前即刻（T4）、撑开1min（T5）、5min（T6）各时间点血压（BP）、心率（HR）、呼吸频率（RR）、血氧饱和度（SpO2）、Narcotrend指数和呼吸抑制、心动过缓、高血压、低血压、恶心呕吐等不良事件及处理用药情况，随访患者和外科医师满意度。结果：与C组比较，D组T4～T6收缩压（SBP）和舒张压（DBP）均降低、Narcotrend指数降低，T3--T6 HR减慢；心动过缓发生率、使用降压药几率、患者满意度和外科医师满意度均更高（P〈0．05）。与T0相比，C组T3 Narcotrend指数降低；D组T4～T6 SBP和DBP降低，T1～T6 HR减慢、Narcotrend指数降低（P〈0．05）。结论：右美托咪定复合舒芬太尼可安全用于局部麻醉下主动脉瘤腔内隔绝术，能够满足术中镇静镇痛需求，患者和外科医师均感满意。

OBJECTIVE： To observe the safety and effects of dexmedetomidine combined with sufentanil in patients with aortic aneurysm undergoing endovascular graft exclusion. METHODS： 60 patients with aortic aneurysm, undergoing selective endovascu- lar graft exclusion in a hospital during Nov. 2011--Mar. 2013 were randomly divided into 2 groups （n=30）, i.e. tramadol com- bined with droperidol group （group C） and dexmedetomidine combined with sulfentanyl group （group D）. All patients underwent surgery under local anesthesia. Group D was given intravenous pumped infusion of dexmedetomidine 0.5 btg/kg（10 min at an even speed） before incision, and then maintained at 0.3-0.7 ~tg/（kg-h） ; it was also given intravenous injection of sufentanil 0.15-0.2 ~tg/ kg before incision and exclusion. Group C was given tramadol 100 mg and Droperidol injection 5 mg dissolved in isometric normal saline 15 min before incision, and received isometric normal saline before incision and exclusion. At the time points of entering op- eration room （To）, 1 min（T~）, 5 min（T2）, 15 rain（T3） after pumped infusion, before exclusion（T4） and 1 min（Ts）, 5 min（%） af- ter exclusion, the BP, HR, RR, SpO2, Narcotrend index and adverse events such as respiratory depression, bradycardia, hyperten- sion, hypotension, nausea and vomiting and treatments were monitored and recorded. The satisfaction degree of patients and sur- geons were followed up. RESULTS： Compared with group C, SBP, DBP and Narcotrend index were decreased at T4-T6 and HR was decreased at T3-T6; the incidence of bradycardia, antihypertensives use and satisfaction degree of patients and surgeons were all higher in group D（P〈0.05）. Compared with To, Narcotred index of group C was decreased at T~; SBP and DBP of group D were decreased at T4-T6, and HR and Narcotrend index were decreased at T3-T6 （P〈0.05）. CONCLUSIONS： Dexmedetomidine com- bined with sufentanil can be safely and effectively used in endovascular graft exclusion of aortic aneurysm patients under local anes- thesia, and meet the demand of intraoperative sedation and analgesia~ Both patients and surgeons have feeling of satisfaction.