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

来源期刊：广州医药 | 1043-1048 发布时间：2024-10-22 收稿时间：2025/11/13 18:45:44 阅读量：29

作者：: 魏颖,

杨学伟,

王志君,

谢淑华,

耿立成,

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; intracranial aneurysm dexmedetomidine propofol etomidate hemodynamics

DOI：: 10.3969/j.issn.1000-8535.2024.09.013

收稿时间：: 2024-03-01
修订日期：
接收日期：
引用总数：: 0

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。

1、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.

2、 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.

3、 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.

4、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.

5、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.

6、 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.

7、 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.

8、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.

9、 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.

10、 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.

11、 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.

12、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.

13、 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.

14、 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.

15、 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.

16、 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.

17、 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.

18、 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.

19、 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.

20、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.

21、 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.

22、 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.

23、 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.

24、 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.

25、 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.

26、 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.