评分目标导向镇痛镇静对主动脉夹层患者术前管理的改良效果

Efficacy of goal-directed analgesia/sedation for improvement in preoperative management of patients with aortic dissection

目的:评价评分目标导向镇痛镇静对主动脉夹层患者术前管理的改良效果。方法:选择本院经主动脉CTA检查确诊为主动脉夹层的患者110例,年龄≥18岁、性别不限,采用随机数字表法分为2组(n=55):常规组和目标导向镇痛镇静组。2组均进行常规术前管理。常规组静脉泵注芬太尼0.13μg/min,调整芬太尼给药速率维持静态数字评分量表(NRS)评分0~3分。目标导向镇痛镇静组静脉泵注咪达唑仑0.02 mg·kg^(-1)·h^(-1)、芬太尼0.13μg/min,调整咪达唑仑和芬太尼泵注速率维持Richmond躁动-镇静量表评分-2~0分,维持静态NRS评分0~3分。2组静脉泵注尼卡地平,调整给药速率维持SBP 100~120 mmHg,口服美托洛尔维持心率60~70次/min。记录达目标血压所需时间、24 h芬太尼及尼卡地平用量,记录镇痛镇静期间药物相关不良反应发生情况和围术期死亡情况。结果:与常规组比较,目标导向镇痛镇静组达目标血压所需时间缩短,24 h芬太尼及尼卡地平用量减少(P<0.05)。2组患者均未见相关不良反应发生,未见围术期死亡发生。结论:评分目标导向镇痛镇静(Richmond躁动-镇静量表评分-2~0分,静态NRS评分0~3分)可更好地控制血压和心率,有助于改善主动脉夹层患者术前管理质量。

Objective To evaluate the efficacy of goal-directed analgesia/sedation for improvement in the preoperative management of the patients with aortic dissection.MethodsOne hundred and ten patients of either sex,aged≥18 yr,diagnosed with arterial dissection by aortic CTA in our hospital,were divided into 2 groups(n=55 each)using a random number table method:conventional group and goal-directed analgesia/sedation group.Routine preoperative management was performed in both groups.Fentanyl 0.13μg/min was intravenously infused,and the infusion rate of fentanyl was adjusted to maintain the numerical rating scale(NRS)score at 0-3 at rest in conventional group.Midazolam 0.02 mg·kg^(-1)·h^(-1) and fentanyl 0.13μg/min were intravenously infused,and the infusion rates of midazolam and fentanyl were adjusted to maintain Richmond agitation-sedation score at-2 to 0 and NRS score at rest 0-3 in goal-directed analgesia/sedation group.Nicardipine was intravenously injected and the administration rate was adjusted to maintain systolic blood pressure at 100-120 mmHg,and metoprolol was taken orally to maintain the heart rate 60-70 beats/min.The time to reach the target blood pressure and consumption of fentanyl and nicardipine within 24 h were recorded,and the occurrence of drug-related adverse reactions during analgesia and sedation and perioperative death were recorded.ResultsCompared with conventional group,the time to reach the target blood pressure was significantly shortened,and the consumption of fentanyl and nicardipine within 24 h was decreased in goal-directed analgesia/sedation group(P<0.05).No adverse reactions or perioperative death was observed in two groups.ConclusionsGoal-directed analgesia/sedation(Richmond Agitation-Sedation Scale score-2-0,NRS score at rest 0-3)is helpful in controlling blood pressure and heart rate,thus improving the quality of preoperative management of patients with aortic dissection.