右美托咪定复合静脉麻醉在急性缺血性脑卒中取栓术中的应用

Application of Dexmetomidine Combined with Intravenous Anesthesia in Thrombolysis in Acute Ischemic Stroke

目的:观察右美托咪定复合镇静麻醉在急性缺血性脑卒中取栓术中应用的安全性、有效性。方法:选择2015年9月-2017年9月时间窗内前循环急性缺血性脑卒中患者60例,按照随机数字表法分为观察组和对照组,各30例。观察组围手术期给予右美托咪定静脉镇静联合股动脉穿刺局部麻醉,对照组单纯给予局部麻醉。观察并记录不同麻醉方法在急性缺血性脑卒中患者机械取栓术中所导致的血流动力学变化、危险因素控制及治疗效果。结果:观察组患者镇静水平评分高于对照组,差异有统计学意义(P<0.001);观察组PTR时间明显短于对照组,差异有统计学意义(P<0.001);观察组术后24 h神经功能NIHSS评分低于对照组,差异有统计学意义(P<0.001);观察组的并发症发生率明显低于对照组,差异有统计学意义(P=0.028);观察组术中血压波动幅度小,<30 mm Hg者占83.33%,高于对照组的43.33%,差异有统计学意义(P=0.001);观察组心率波动幅度小,<30次/min者占80.00%,高于对照组的40.00%,差异有统计学意义(P=0.001);两组的血氧饱和度比较,差异无统计学意义(P=0.157)。结论:右美托咪定复合局部麻醉可安全应用于急性脑卒中机械取栓治疗,能显著缩短手术操作时间,使手术过程稳定,降低手术风险,提高患者神经功能恢复程度。

Objective:To observe the safety and efficacy of Dexmetomidine combined with sedation anesthesia in thrombectomy in acute ischemic stroke.Method:60 patients with acute ischemic stroke from September 2015 to September 2017 were selected,they were divided into the observation group and control group,according to the random number table method,30 cases in each group.The observation group received intravenous sedation of Dexmetomidine and local anesthesia by femoral artery puncture during perioperative period,the control group was given only local anesthesia.The hemodynamic changes,risk factors control and therapeutic effect of different anesthetic methods during mechanical thrombectomy in patients with acute ischemic stroke were observed and recorded.Result:The score of sedation level in the observation group was higher than that in the control group,the difference was statistically significant(P<0.001).The time of PTR in the observation group was significantly shorter than that in the control group,the difference was statistically significant(P<0.001).The score of 24 h nerve function NIHSS in the observation group was lower than that of the control group,the difference was statistically significant(P<0.001).The incidence of complications in the observation group was significantly lower than that in the control group,the difference was statistically significant(P=0.028).The fluctuation of blood pressure in observation group was small,the proportion of<30 mm Hg was 83.33%,which was higher than 43.33%of the control group,the difference was statistically significant(P=0.001).In the observation group,the amplitude of heart rate fluctuation was small,the proportion of<30 times/min was 80.00%,which was higher than 40.00%that of the control group,the difference was statistically significant(P=0.001).There was no significant difference in blood oxygen saturation between the two groups(P=0.157).Conclusion:Dexmedetomidine Hydrochloride Injection compound topical anesthesia is safe applied to machinery in treating acute brain stroke,can significantly shorten the operation time,operation stable,reduce the operation risk and improve the degree of patients with neurological recovery.