右美托咪定联合丙泊酚或依托咪酯对颅内动脉瘤介入术患者围插管期血流动力学的影响

doi:10.3969/j.issn.1000-8535.2024.09.013

摘要/Abstract

摘要： 目的探讨右美托咪定（Dex）分别联合丙泊酚或依托咪酯在颅内动脉瘤介入术中的镇静效果及对患者血流动力学的影响。方法将60例颅内动脉瘤介入术患者按照随机数表法分为A组（Dex+丙泊酚,n=30）、B组（Dex+依托咪酯,n=30）。记录两组不同时间点的平均动脉压（MAP）、心率（HR）,比较苏醒期的镇静效果、呛咳程度、拔管时间、苏醒时间、清醒时间及术后不良反应。结果 A组患者T₁MAP、HR为（84.56±5.13）mmHg、（65.87±5.14）次/分和T₂（83.29±5.47）mmHg、（65.87±5.14）次/分均低于B组T₁（87.89±3.88）mmHg、（70.22±5.67）次/分和T₂（86.71±3.75）mmHg、（69.97±5.87）次/分（t分别为2.836、2.825、3.113、3.391,均P<0.001）。两组苏醒期各项指标和躁动（10.00% vs 0%,P=0.757）、呼吸抑制发生率（3.33% vs 0%,P=0.313）比较差异均无统计学意义（均P>0.05）,A组恶心、呕吐发生率（3.33%）较B组（20.00%）更低（χ²=4.043,P=0.044）。结论 Dex联合丙泊酚、依托咪酯麻醉在颅内动脉瘤介入术中均可发挥良好安全的麻醉作用,降低患者术后躁动和呼吸抑制的发生率,使用Dex联合依托咪酯在患者围插管期的血流动力学的稳定性效果更好,但在降低患者术后恶心呕吐的风险方面效果较差。

关键词: 颅内动脉瘤, 右美托咪定, 丙泊酚, 依托咪酯, 血流动力学

Abstract: Objective To evaluate the sedative effect of dexmedetomidine（Dex）combined with propofol or etomidate during cerebral aneurysm intervention and its effect on patient hemodynamics．Methods A total of 60 cerebral aneurysm patients were randomly divided into two groups：Group A（Dex + propofol,n=30）and Group B（Dex + etomidate,n=30）．Mean arterial pressure（MAP）and heart rate（HR）were recorded at different time points in the two groups,and the sedation effect,choking degree,extubation time,waking up time,waking time and postoperative side effects were compared．Results T₁ MAP,HR of（84.56±5.13）mmHg,（65.87±5.14）times / min and T₂（83.29±5.47）mmHg,（65.87±5.14）times / min in group A were lower than those in group B T₁（87.89±3.88）mmHg,（70.22±5.67）times / min and T₂（86.71±3.75）mmHg,（69.97±5.87）times / min（t=2.836,2.825,3.113,3.391,all P<0.001）．There was no significant difference in the incidence of emergence agitation（10.00 % vs 0.00 %,P=0.757）and respiratory depression（3.33 % vs 0.00 %,P=0.313）between the two groups（P>0.05）．The incidence of nausea and vomiting in group A（3.33 %）was lower than that in group B（20.00 %）（χ²=4.043,P=0.044）．Conclusions Dex combined with propofol and etomidate anesthesia can have a good and safe anesthesia effect in intracranial aneurysm intervention,and reduce the incidence of postoperative agitation and respiratory depression in patients．Hemodynamic stabilization during the tube phase is more effective,but less effective in reducing the risk of postoperative nausea and vomiting in patients．

Key words: intracranial aneurysm, dexmedetomidine, propofol, etomidate, hemodynamics

魏颖, 杨学伟, 王志君, 谢淑华, 耿立成. 右美托咪定联合丙泊酚或依托咪酯对颅内动脉瘤介入术患者围插管期血流动力学的影响[J]. 广州医药, 2024, 55(9): 1043-1048.

WEI Ying, YANG Xuewei, WANG Zhijun, XIE Shuhua, GENG Licheng. Effect of dexmedetomidine combined with propofol or etomidate on periintubation hemodynamics in cerebral aneurysm patients[J]. Guangzhou Medical Journal, 2024, 55(9): 1043-1048.

参考文献

[1] TAWK R G,HASAN T F,D'SOUZA C E,et al.Diagnosis and treatment of unruptured intracranial aneurysms and aneurysmal subarachnoid hemorrhage[J].Mayo Clin Proc,2021,96(7):1970-2000.
[2] MEHTA V A,SPEARS C A,ABDELGADIR J,et al.Management of unruptured incidentally found intracranial saccular aneurysms[J].Neurosurg Rev,2021,44(4):1933-1941.
[3] LIU H J,ZHOU H,LU D L,et al.Intracranial mirror aneurysm:Epidemiology,rupture risk,new imaging,controversies,and treatment strategies[J].World Neurosurg,2019(127):165-175.
[4] ANDRADE L,HOSKOPPAL A,HUNT MARTIN M,et al.Intracranial aneurysm and coarctation of the aorta:Prevalence in the current era[J].Cardiol Young,2021,31(2):229-232.
[5] PENG F,NIU H,FENG X,et al.Aneurysm wall enhancement,atherosclerotic proteins,and aneurysm size may be related in unruptured intracranial fusiform aneurysms[J].Eur Radiol,2023,33(7):4918-4926.
[6] VEET C A,CAPONE S,PANCZYKOWSKI D,et al.Imaging versus intervention in managing small unruptured intracranial aneurysms:A cost-effectiveness analysis[J].Cerebrovasc Dis,2022,51(3):338-348.
[7] 黄清海,杨鹏飞.颅内动脉瘤血管内介入治疗中国专家共识(2013)[J].中国脑血管病杂志,2013,10(11):606-616.
[8] PIEROT L,BARBE C,HERBRETEAU D,et al.Immediate post-operative aneurysm occlusion after endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1189 patients:Analysis of recanalization after endovascular treatment of intracranial aneurysm(ARETA)study[J].J Neurointerv Surg,2021 ,13(10):918-923.
[9] LI Z,LIU Q,YAO J,et al.Effects of supplemental dexmedetomidine anesthesia on intracranial aneurysm patients undergoing intracranial interventional embolization[J].World Neurosurg,2022(168):e570-e577.
[10] ESMAEELI S,MOTAYAGHENI N,BASTOS BRENES A,et al.Propofol-based anesthesia maintenance and/or volatile anesthetics during intracranial aaneurysm repair:A comparative analysis of neurological outcomes[J].J Clin Med,2023,12(21):6954.
[11] WANG B,PENG G,CHEN L,et al.Effect of transcutaneous electrical acupoint stimulation on remifentanil dosage during craniotomy aneurysm clipping:A prospective,randomized controlled study[J].BMC Complement Med Ther,2023,23(1):453.
[12] XING Y,LIN N,HAN R,et al.Sevoflurane versus propofol combined with remifentanil anesthesia impact on postoperative neurologic function in supratentorial gliomas(SPRING):Protocol for a randomized controlled trial[J].BMC Anesthesiol,2020,20(1):117.
[13] HE X,CHENG K M,ZHANG L,et al.Dexmedetomidine for the prevention of postoperative delirium in patients after intracranial operation for brain tumours(DEPOD study):A study protocol and statistical plan for a multicentre randomised controlled trial[J].BMJ Open,2020,10(11):e040939.
[14] LEE W H,PARK C K,PARK H P,et al.Effect of dexmedetomidine combined anesthesia on motor evoked potentials during brain tumor surgery[J].World Neurosurg,2019(123):e280-e287.
[15] 高勤,左友波,刘琪琳.不同右美托咪定给药方式对颅内动脉瘤患者栓塞术后苏醒期血流动力学及应激反应的影响[J].山东医药,2022,62(16):61-64.
[16] GUO Z,WANG W,XIE D,et al.Effect of supplemental dexmedetomidine in interventional embolism on cerebral oxygen metabolism in patients with intracranial aneurysms[J].J Int Med Res,2021,49(4):3000605211002960.
[17] ZHENG D,ZHAO S,ZHANG N,et al.Brain protective effect and hemodynamics of dexmedetomidine hydrochloride in patients with intracranial aneurysm[J].Saudi J Biol Sci,2020,27(7):1850-1855.
[18] SOLEIMANI A,HEIDARI N,HABIBI M R,et al.Comparing hemodynamic responses to diazepam,propofol and etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery:A double-blind,randomized clinical trial[J].Med Arch,2017,71(3):198-203.
[19] 周辉,徐振锋.托烷司琼预处理配合丙泊酚全身麻醉对预防PONV的价值[J].广州医药,2024,55(2):146-150,202.
[20] KOTANI Y,PIERSANTI G,MAIUCCI G,et al.Etomidate as an induction agent for endotracheal intubation in critically ill patients:A meta-analysis of randomized trials[J].J Crit Care,2023(77):154317.
[21] ALBERT S G,SITAULA S.Etomidate,adrenal insufficiency and mortality associated with severity of illness:A meta-analysis[J].J Intensive Care Med,2021,36(10):1124-1129.
[22] 张维义,哈思远,苑广超,等.瑞马唑仑对颅内动脉瘤介入治疗围手术期血流动力学的影响[J].中国临床神经外科杂志,2022,27(8):684-686.
[23] 李文君,刘宜平,李恩有.右美托咪定复合依托咪酯靶控静脉麻醉的临床研究[J].哈尔滨医科大学学报,2021,55(2):137-140.
[24] LU Z,ZHENG H,CHEN Z,et al.Effect of etomidate vs propofol for total intravenous anesthesia on major postoperative complications in older patients:A randomized clinical trial[J].JAMA Surg,2022,157(10):888-895.
[25] FENG Y,CHEN X B,ZHANG Y L,et al.Propofol decreased the etomidate-induced myoclonus in adult patients:A meta-analysis and systematic review[J] Eur Rev Med Pharmacol Sci,2023,27(4):1322-1335.
[26] 杨玉峰,赵冰清,曾毅.艾司氯胺酮泵注对依托咪酯靶控输注所致苏醒期躁动的影响[J].临床麻醉学杂志,2024,40(2):165-169.