去氧肾上腺素与多巴胺在缺血性脑卒中合并心房颤动患者神经介入术中的应用

The comparisons of phenylephrine and dopamine for interventional neuroradiological procedures in patients with ischemic cerebral stroke complicated with atrial fibrillation

目的比较去氧肾上腺素与多巴胺在缺血性脑卒中合并心房颤动患者神经介入手术中应用的效果。方法选择拟在全麻下行血管内介入治疗的缺血性脑卒中合并心房颤动患者30例,性别不限,年龄55~78岁、BMI为19~30 kg/m^2、ASA分级Ⅱ-Ⅲ级,随机分为A、B组(每组15例):A组患者于手术开始时(T_1)至支架成功植入或拉栓成功前10 min(T_4)持续静脉泵注去氧肾上腺素[剂量为0.4~0.8μg/(kg·min)];B组患者在此期间持续泵注多巴胺[剂量为5~15μg/(kg·min)],此期间均维持两组患者血压在基础值水平,在支架植入成功后或拉栓成功后维持患者血压在基础值水平低限,防止脑血管再通后的高灌注损伤。观察并记录两组患者各时间点平均动脉压(MAP)、心率(HR)变化及术中心律失常(不包含快速房颤)、快速房颤的情况和患者的平均尿量。结果 2组患者均维持了良好的MAP,B组患者T_2、T_3、T_4各时间点HR均高于A组;B组患者出现心律失常和快速房颤的比例高于A组;2组患者平均尿量无明显差异。结论在缺血性脑卒中合并心房颤动患者行神经介入治疗术时,应用去氧肾上腺素可维持患者血流动力学平稳、控制心率降低心肌耗氧又可减少心律失常发生率,其疗效明显优于多巴胺。

Objective To compare the effects of phenylephrine and dopamine for interventional neuroradiological procedures in patients with ischemic cerebral stroke complicated with atrial fibrillation. Methods A total of 30 male and female patients with their age ranged 55-78 years old, BMI 19-30 kg/m^2, ASAⅡ-Ⅲ with ischemic cerebral stroke complicated with atrial fibrillation were divided into two groups（n=15）. Continuous intravenous pumping of phenylephrine [0.4-0.8 μg/（kg· min）] was used in group A between the time of the beginning of the operation and the time when the balloon was placed or 10 minutes before thrombus was successfully pulled out, while patients in the group B was pumped with dopamine [5-15 μg/（kg· min）]. Blood pressure Patients in both groups were kept to the baseline value in this period. When the balloon was placed or thrombus was successfully pulled out, the blood pressure was kept below the baseline value to prevent the high perfusion damage after cerebral vascular recanalization. MAP, HR, the urine volume of patients, the condition of arrhythmia and rapid atrial fibrillation in the two groups were observed at different time points during the operation. Results Both groups of patients were maintained a good MAP. The HR in group B at T_2、T_3、T_4 points were higher than those of group A. The incidence of arrhythmia and rapid atrial fibrillation were higher than that of group A. There was no evident difference between the two groups in average urine volume. Conclusion Phenylephrine is better than dopamine in maintaining the steadiness of hemodynamics and reducing the incidence of arrhythmia in patients for interventional neuroradiological procedures with ischemic cerebral stroke complicated with atrial fibrillation.