胸腹主动脉瘤腔内覆膜支架置入术中右美托咪啶的控制性降压效果

Application of dexmedetomidine for controlled hypotension during placement of endovascular stent graft in thoracoabdominal aortic aneurysm

目的比较右美托咪啶与硝普钠用于胸腹主动脉瘤腔内覆膜支架置入术中控制性降压的效果。方法选择北京安贞医院血管科2016年9月至2017年4月收治的60例择期局麻下胸腹主动脉瘤腔内覆膜支架置入术患者,采用随机数表法分为硝普钠组(n=30)与右美托咪啶组(n=30),分别在术中静脉泵注硝普钠0.2~3μg/(kg·min)或右美托咪啶0.2~1μg/(kg·h)。记录患者术中的收缩压、舒张压、心率、脉搏氧饱和度与Ramsay镇静评分。结果右美托咪啶组患者的心率在手术开始后30 min、支架释放时及术毕时分别为(71±9)次/min、(67±7)次/min与(68±8)次/min,低于硝普钠组的(87±12)次/min、(91±14)次/min与(85±9)次/min,差异均具有统计学意义(P<0.05);手术开始后30 min、支架释放时及术毕时右美托咪啶组患者的Ramsay镇静评分为(2.8±0.5)分、(3.5±0.4)分与(2.4±0.3)分,优于硝普钠组的(1.5±0.4)分、(1.4±0.3)分与(1.5±0.5)分,差异均有统计学意义(P<0.05);硝普钠组术中有6例患者发生恶心呕吐,右美托咪啶组术中无患者发生恶心呕吐,差异具有统计学意义(P<0.05)。结论右美托咪啶用于胸腹主动脉瘤腔内覆膜支架置入术中,其控制性降压效果优于硝普钠,且具有镇静、镇痛、恶心呕吐少的优点。

Objective To explore the application of dexmedetomidine for controlled hypotension during place- ment of endovascular stent graft in thoracoabdominal aortic aneurysm. Methods Sixty patients with thoracoabdominal aortic aneurysm performing endovascular stent graft placement at Department ofAngiology of Anzhen Hospital of Capital Medical University from September 2016 to April 2017 were divided into the sodium nitroprusside group （n=30） and the dexmedetomidine group （n=30） according to random number table method, receiving intravenous sodium nitropms- side 0.2-3 μg/（kg-min） or dexmedetomidine 0.2-1 μg/（kg.min） respectively for controlled hypotension intraoperatively. The systolic blood pressure, diastolic blood pressure, heart rate, pulse oxygen saturation and Ramsay sedation score were recorded. Results The heart rates at 30 min post incision, time of graft releasing and end of operation in the dexmedeto- midine group were respectively （71±9） beats/min, （67±7） beats/rain, （68±8） beats/min, which were significantly lower than corresponding （87±12） beats/min, （91±14） beats/min, （85±9） beats/min in the nitroprusside group （P〈0.05）. Ramsay sedation scores at 30 min post incision, time of graft releasing and end of operation in the dexmedetomidine group were respectively （2.8±0.5）, （3.5±0.4）, （2.4±0.3）, which were significantly lower than corresponding （1.5±0.4）, （1.4±0.3）, （1.5±0.5） in the nitroprusside group （P〈0.05）. There was significant difference between the dexmedetomidine group and the nitroprusside group in the incidence of nausea and vomiting （0 case vs 6 cases, P〈0.05）. Conclusion Dexmedetomi- dine is a better choice than sodium nitroprusside for controlled hypotension during placement of endovascular stent graft in thoracoabdominal aortic aneurysm, with good sedative, analgesic and anti-nausea and vomiting effects.