急性缺血性脑卒中支架取栓术中应用小剂量芬太尼联合咪达唑仑的护理

Nursing of sedation and analgesia using low-dose fentanyl with midazolam during thrombectomy for anterior-circulation acute ischemic stroke

目的探讨急性前循环缺血性脑卒中患者支架取栓术中应用小剂量芬太尼联合咪达唑仑的镇静镇痛作用和术中护理要点。方法收集急性前循环缺血性脑卒中拟行支架取栓术的患者61例，根据医嘱执行个体化镇静方案：对照组30例使用咪达唑仑静脉注射负荷量后，视患者镇静效果予维持剂量，试验组31例在对照组的基础上增加小剂量芬太尼持续泵注，由同一组手术医生行支架取栓术，比较2组患者术中生命体征、呼吸曲线以及SpO2变化，评估术中Ramsay镇静评分，记录患者术中躁动及镇静不良反应的发生情况，针对术中镇静情况实施护理干预。结果61例患者术中医护配合良好，无颅内出血病例，无术中死亡病例。术中对照组Ramsay 1分镇静状态发生4例，躁动导致数字减影血管造影图像伪影发生3例，1例SpO2轻度降低，4例取栓过程中发生呕吐，1例平均动脉压略有下降。试验组无Ramsay 1分镇静状态患者，术中SpO2下降5例，呼吸抑制发生3例，3例平均动脉压略有降低。结论应用小剂量芬太尼联合咪达唑仑在急性前循环缺血性脑卒中支架取栓术中镇静镇痛安全可靠，但术中需密切监测患者呼吸频率曲线的改变和SpO2的变化，积极预防呼吸抑制的发生。

Objective To investigate the nursing of sedation and analgesia using low-dose fentanyl with midazolam during intra-arterial treatment with mechanical thrombectomy by means of stent for patients with anterior-circulation acute ischemic stroke. Methods All of 61 patients who underwent intra-arterial treatment with anterior-circulation acute ischemic stroke were retrospectively collected. They were divided into two groups according to the different program of individual conscious sedation： the control group （30 cases） used midazolam for intravenous maintain sedation, experimental group （31 cases） added the low-dose fentanyl on the basis of the control group. The thrombectomy was performed by the same group of interventional radiologists, while the effect of sedative, vital signs, respiratory curve and SpO2 （blood oxygen saturation）, assessment of Ramsay＇s sedation score, restlessness and other sedation adverse reactions were respectively observed in both groups. Nursing intervention was performed aiming at different states of patients during operation. Results All 61 patients were implemented with good medical care with no intracranial hemorrhage or intraoperative death. In the control group, there were 4 patients with Ramsay 1 point of sedation, resulted motion artifacts in digital subtraction angiography images in 3 of them, 1 patient with slight reduction of SpO2, and vomiting in 4 patients. 1 patient with decreased mean arterial pressure. In the experimental group, there was no Ramsay 1 point of sedative patient. The SpO2 was decreased in 5 patients. Respiratory inhibition occurred in 3 patients and the mean arterial pressure decreased slightly in the other 3 patients. Conclusions Application of low-dose fentanyl and midazolam is safe and reliable in patients who underwent intra-arterial treatment with anterior-circulation acute ischemic stroke. While closely observation to the changes of breath frequency curve and SpO2 in operation are very essential to actively prevent the occurrence of respiratory depression.