瑞马唑仑复合瑞芬太尼行非插管全身麻醉在下肢深静脉血栓AngioJet机械血栓清除术中的安全性及有效性研究

Safety and Efficacy of Non-Intubated General Anesthesia with Remimazolam Combined with Remifentanil in AngioJet Mechanical Thrombectomy for Lower Extremity Deep Vein Thrombosis

目的:探讨瑞马唑仑复合瑞芬太尼行非插管全身麻醉用于下肢深静脉血栓AngioJet机械血栓清除术的安全性及有效性。方法:纳入2021年10月至2023年10月于临沂市人民医院行下肢深静脉血栓AngioJet机械血栓清除术的患者120例,采用随机数字表法分为非插管全身麻醉组(n=60)与清醒镇静组(n=60)。非插管全身麻醉组患者行瑞马唑仑复合瑞芬太尼非插管全身麻醉,清醒镇静组患者行清醒镇静麻醉。比较两组患者入室(T_(1))、靶血管穿刺(T_(2))、喷洒药物(T_(3))、喷洒药物后15 min(T_(4))、吸栓(T_(5))、手术结束5 min(T_(6))、术后1 h(T_(7))、术后4 h(T_(8))、术后12 h(T_(9))时的血流动力学指标,包括收缩压(SBP)、舒张压(DBP)、心排血量(CO)、外周血管阻力(SVR)、每搏输出量、心率。记录并比较两组患者术中和术后抗高血压药使用情况、血红蛋白尿及不良事件发生情况、靶血管穿刺时间、患者满意度评分及医师满意度评分。结果:(1)T_(1)—T_(9)时,两组患者的SBP、DBP组内比较,差异均有统计学意义(P<0.001)。两组患者的SBP、DBP均在T_(3)时开始升高,T_(9)时恢复正常。非插管全身麻醉组患者在T_(2)—T_(5)时的SBP、DBP较清醒镇静组显著降低,差异均有统计学意义(P<0.001)。(2)T_(1)—T_(6)时,两组患者的SVR、CO组内比较,差异均有统计学意义(P<0.001)。T_(3)—T_(6)时两组患者的SVR逐渐升高,T_(2)—T_(5)时两组患者的CO逐渐降低。在T_(2)—T_(6)各时间点,非插管全身麻醉组患者的SVR较清醒镇静组显著降低,差异均有统计学意义(P<0.05)。在T_(3)—T_(6)各时间点,非插管全身麻醉组患者的CO较清醒镇静组显著提高,差异均有统计学意义(P<0.05)。(3)非插管全身麻醉组的医师满意度评分、患者满意度评分较清醒镇静组显著提高,差异均有统计学意义(P<0.001)。(4)非插管全身麻醉组患者术中抗高血压药使用率、体动发生率、术中严重高血压及高血压亚急症发生率均较清醒镇静组显著降低,差异均有统计学意义(P<0.001)。结论:瑞马唑仑复合瑞芬太尼行非插管全身麻醉在下肢深静脉血栓AngioJet机械血栓清除术中具有较好的安全性及有效性。

OBJECTIVE:To probe into the safety and efficacy of non-intubated general anesthesia with remimazolam combined with remifentanil in AngioJet mechanical thrombectomy for lower extremity deep vein thrombosis.METHODS:Totally 120 patients who underwent AngioJet mechanical thrombectomy for lower extremity deep vein thrombosis in Linyi People’s Hospital from Oct.2021 to Oct.2023 were extracted to be divided into the non-intubated general anesthesia group(n=60)and awake sedation group(n=60)through the random number table method.The non-intubated general anesthesia group received remimazolam combined with remifentanil for non-intubated general anesthesia,while the awake sedation group was given awake sedation anesthesia.Vital signs of two groups of patients,including systolic blood pressure(SBP),diastolic blood pressure(DBP),cardiac output(CO),systemic vascular resistance(SVR),stroke volume and heart rate were compared at at the time of admission(T_(1)),target vessel puncture(T_(2)),drug spraying(T_(3)),15 minutes after drug spraying(T_(4)),thrombus aspiration(T_(5)),and 5 minutes after surgery(T_(6)),1 hour after surgery(T_(7)),4 hours after surgery(T_(8)),and 12 hours after surgery(T_(9)).The use of antihypertensive drugs during and after surgery,occurrence of hematuria and adverse events,target vessel puncture time,patients’satisfaction score,and clinicians’satisfaction score were recorded and compared between two groups.RESULTS:(1)From T_(1) to T_(9),there were statistically significant differences within the SBP and DBP groups between the non-intubated general anesthesia group and awake sedation group(P<0.001).Both groups showed an increase in SBP and DBP at T_(3) and returned to normal at T_(9).The non-intubated general anesthesia group showed a significant decrease in SBP and DBP from T_(2) to T_(5) compared with the awake sedation group,with statistically significant difference(P<0.001).(2)From T_(1) to T_(6),there were statistically significant differences with SVR and CO groups between the non-intubated general anesthesia group and awake sedation group(P<0.001).SVR increased in both groups from T_(3) to T_(6),while CO decreased in both groups from T_(2) to T_(5).At various time points from T_(2) to T_(6),SVR of the non-intubated general anesthesia group was significantly lower than that of the awake sedation group,with statistically significant difference(P<0.05).At various time points from T_(3) to T_(6),CO in the non-intubated general anesthesia group were significantly higher than those in the awake sedation group,with statistically significant difference(P<0.05).(3)The clinicians’satisfaction score and patients’satisfaction score in the non-intubation general anesthesia group were significantly higher than those in the wake sedation group,with statistically significant differences(P<0.001).(4)The use rate of antihypertensive drugs during surgery,the incidence of body movements,the incidence of severe hypertension and hypertensive subacute disease during surgery in the non-intubated general anesthesia group were significantly lower than those in the wake sedation group,with statistically significant differences(P<0.001).CONCLUSIONS:Remazolam combined with remifentanil for non-intubation general anesthesia has good safety and efficacy in AngioJet mechanical thrombectomy for lower extremity deep vein thrombosis.