右美托咪定联合丙泊酚在主动脉瓣重度狭窄老年患者经导管主动脉瓣置换术中麻醉效果评价

Efficacy of dexmedetomidine combined with propofol in transcatheter aortic valve replacement in elderly patients with severe aortic stenosis

目的探讨右美托咪定联合丙泊酚在主动脉瓣重度狭窄老年患者经导管主动脉瓣置换术(TAVR)中麻醉的效果。方法选取80例行TAVR术的主动脉瓣重度狭窄患者为研究对象,采用随机数字表法分为丙泊酚组(P组)与右美托咪啶联合丙泊酚组(DP组),每组40例。比较两组术中丙泊酚使用量、气道干预率、术中出入量、手术时间、苏醒时间、ICU驻留时间、术后住院时间、术后补救镇痛率、低血压、心动过缓及术后焦虑等。结果DP组的术中丙泊酚用量、低血压发生率和气道干预率明显低于P组,心动过缓发生率明显高于P组,差异有统计学意义(P<0.05)。DP组术后4、8、12 h静息和运动时的视觉模拟评分均显著低于P组,差异有统计学意义(P<0.05)。DP组术后羟考酮使用率、焦虑发生率明显低于P组,ICU驻留时间、术后住院时间明显短于P组,差异有统计学意义(P<0.05)。结论右美托咪定联合丙泊酚用于主动脉瓣重度狭窄老年患者TAVR术中麻醉效果较好,可减少丙泊酚的用量和人工气道的干预,使呼吸及血流动力学更平稳,有助于术后早期康复,缩短住院时间。

Objective To investigate the anesthetic effect of dexmedetomidine combined with propofol in transcatheter aortic valve replacement(TAVR)in elderly patients with severe aortic stenosis.Methods A total of 80 patients with severe aortic stenosis undergoing TAVR were selected as the study objects and divided into propofol group(P group)and dexmedetomidine combined with propofol group(DP group)by random number table method,with 40 cases in each group.The use of propofol,airway intervention rate,intraoperative access,operation time,recovery time,ICU stay time,postoperative hospital stay,postoperative analgesia rate,hypotension,bradycardia,postoperative anxiety and so on were compared between the two groups.Results The intraoperative propofol dosage,incidence of hypotension and airway intervention rate in DP group were significantly lower than those in P group,and the incidence of bradycardia was significantly higher than that in P group,with statistical significance(P<0.05).The visual simulation scores at rest and exercise at 4,8 and 12 hours in DP group were significantly lower than those in P group,with statistical significance(P<0.05).The rate of oxycodone usage and anxiety in DP group were significantly lower than those in P group,and the duration of ICU stay and postoperative hospital stay in DP group were significantly shorter than those in P group,with statistical significance(P<0.05).Conclusion Dexmedetomidine combined with propofol has good anesthetic effect in elderly patients with severe aortic stenosis during TAVR operation,which can reduce the dosage of propofol and intervention of artificial airway,make respiration and hemodynamics more stable,contribute to early postoperative rehabilitation and shorten hospital stay.