瑞芬太尼静脉麻醉在前循环急性缺血性卒中机械取栓治疗中的疗效

Application of remifentanil intravenous anesthesia for mechanical thrombectomy in patients with acute anterior circulation stroke

目的探讨瑞芬太尼在急性前循环大血管闭塞性卒中机械取栓(MT)中的疗效。方法选择前循环急性缺血性卒中行MT治疗患者108例,按照麻醉不同分为瑞芬太尼组(A组)、丙泊酚组(B组)和局麻组(C组),每组36例。记录三组患者术中心率(HR)、平均动脉压(MAP)、血氧饱和浓度(SpO2)、患者躁动、血管活性药物使用、穿刺至再通时间、早期症状改善、术后24小时梗死体积及相关并发症情况。结果 B组HR和MAP低于A和C组,差异有统计学意义(P<0.05)。三组HR下降>30次/min、术中MAP下降>40%基线值、术中躁动和术中血管活性药物使用的人数比较,差异有统计学意义(P<0.05)。三组呼吸暂停人数比较,差异有统计学意义(P<0.05);A组穿刺至再通时间最短,差异有统计学意义(P<0.05)。结论瑞芬太尼用于前循环急性缺血性卒中MT治疗的镇静麻醉同丙泊酚一样安全有效,且瑞芬太尼更有利于维持术中的血流动力学稳定,但需要注意相关呼吸抑制事件的发生。

Objective To observe the safety and efficacy of remifentanil intravenous anesthesia for mechanical thrombectomy(MT)in patients with acute anterior circulation stroke.Method 108 patients with anterior circulation acute ischemic stroke treated with MT were divided into remifentanil group(group A),propofol group(group B)and local anesthesia group(group C)according to different anesthesia,36 cases in each group.heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2),patient agitation,use of vasoactive drugs,time from puncture to recanalization,improvement of early symptoms,24-hour infarct volume and related complications were recorded.Result HR and MAP in group B were lower than those in group A and C,the difference was statistically significant(P<0.05).There were significant differences in HR decrease>30 times/min,intraoperative MAP decrease>40%baseline value,intraoperative agitation and intraoperative use of vasoactive drugs among the three groups(P<0.05).There was significant difference in the number of apnea patients among the three groups(P<0.05),and the shortest time from puncture to recanalization was found in group A,the difference was statistically significant(P<0.05).Conclusion The safety and availability of remifentanil intravenous anesthesia for mechanical thrombectomy in patients with acute anterior circulation stroke is the same as propofol,and remifentanil is more likely to maintain hemodynamic stability,but relevant respiratory adverse events should be noticed.