不同剂量右美托咪定在胸主动脉瘤患者支架介入手术中的应用效果观察

Observation on Application of Different Dose Dexmedetomidine on Patients with Thoracic Aortic Aneurysm Undergoing Endovascular Graft Exclusion

目的：观察不同剂量右美托咪定在胸主动脉瘤患者支架介入手术中的应用效果,为临床用药提供参考。方法：选择美国麻醉医师协会（ASA）分级Ⅱ~Ⅲ级择期在局麻下行胸主动脉瘤支架介入手术的患者60例,随机分为3组,每组20例。手术局麻前30 min分别静脉给予右美托咪定0.5μg/kg（D1组）、0.7μg/kg（D2组）、1μg/kg（D3组）,之后各组以0.4μg/（kg·h）恒速维持直至手术结束。记录给药前（T0）、给药后10 min（T1）、给药后20 min（T2）、手术切皮时（T3）及术中释放支架前即刻（T4）的收缩压（SBP）、心率（HR）、经皮血氧饱和度（Sp O2）及脑电双频指数（BIS）,并记录术中控制性降压使用硝酸甘油的剂量,有无呼吸抑制、心动过缓或心动过速等不良反应。结果：与T0比较,3组患者给药后T1~T4时SBP、HR、BIS均降低（P〈0.05或P〈0.01）。与D1组比较,D2、D3组BIS在给药后T1~T4时明显降低（P〈0.05）。D3组HR在T2时较D1、D2组明显降低（P〈0.05）。D3组较D1、D2组心动过缓发生率明显增多（P〈0.05）。D2、D3组术中控制性降压使用硝酸甘油的剂量较D1组明显减少（P〈0.05）,而D2组与D3组组间比较差异无统计学意义（P〉0.05）。结论：在局麻下胸主动脉瘤支架介入手术前,静脉给予右美托咪定0.7μg/kg,之后以0.4μg/（kg·h）恒速维持,镇静镇痛效果满意,围术期血流动力学稳定,且可减少血管活性药用量。

OBJECTIVE： To observe the effect of different doses of dexmedetomidine on perioperative patients with thoracic aortic aneurysm undergoing stent intervention surgery, and provide reference for the rational drug use. METHODS： 60 ASA 1/ or Ⅲ patients with thoracic aortic aneurysm, undergoing selective stent intervention surgery under local anesthesia were randomly divided into 3 groups （n=20）. Each group was given intravenous pumped infusion of dexmedetomidine 0.5 μg/kg （group D1 ）, or 0.7 μg/kg （group D2）, or 1μg/kg （group D3） 30 min before local anesthesia, and then maintained at 0.4μg/（kg.h） until the end of surgery. At the time point of before medication （To）, 10 min （Tt） and 20 min （T2） after pumped infusion, just after incision （T3）, and before exclusion （T4）, SBP）, HR, SpO2 and bispectral index （BIS）, the dose of nitroglycerin during controlled hypotension, and ADR such as respiratory depression, bradycardia, tachycardia, were monitored and recorded. RESULTS： Compared with To, SBP, HR and BIS of 3 groups at the time of T1 to T4 were decreased （P〈0.05 or P〈0.01）. Compared with group D1, BIS of group D2 and D3 were decreased significantly at the time of T1 to T4 （P〈0.05）. HR of group D3 was lower than that of group D1 and D2 at the time of T2 （P〈0.05）. The incidence of bradycardia in group D3 was higher than in group D1 and D2 （P〈0.05）. The dose of nitroglycerin during controlled hypotension in group D2 and D3 were lower than in group D1 （P〈0.05）, but there were no statistical difference between group D2 and D3. CONCLUSIONS： What intravenous pumped infusion of dexmedetomidine 0.7μg/kg 30 min before local anesthesia and then maimained at 0.4μg/（kg-h） during thoracic aortic aneurysm stem intervention surgery, can satisfy the effect of intraoperative sedation and analgesia, and stabilize hemodynamics, and reduce the dose of vasoactive drugs.