2022 年第 6 期 第 17 卷

不同剂量右美托咪定复合舒芬太尼在胸主动脉腔内修复术中的应用

Application of different doses of dexmedetomidine combined with sufentanil in thoracic endovascular aortic repair

作者：李术榕李响王菲马骏

英文作者：Li Shurong Li Xiang Wang Fei Ma Jun

单位：首都医科大学附属北京安贞医院麻醉中心，北京100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：

英文关键词：Dexmedetomidine;Sufentanil;Thoracicendovascularaorticrepair;Observer′sassessmentofalertness/sedationscore

• 摘要：

• 目的 探讨不同剂量右美托咪定复合舒芬太尼在胸主动脉腔内修复术（TEVAR）中的麻醉效果及安全性。方法 选择2018年12月至2019年8月在首都医科大学北京安贞医院接受TEVAR治疗的Stanford B型主动脉夹层患者60例。按照随机数字表法分为D1组、D2组和D3组，各20例。手术开始前3组在20 min内分别按照0.6、0.8、1.0 μg/kg负荷量输注右美托咪定，同时给予舒芬太尼0.3 μg/kg缓慢静脉滴注，然后持续泵注右美托咪定0.3、0.4、0.5 μg/（kg·h），手术完成后停止泵入。观察3组患者入室时(T0)、右桡动脉穿刺时(T1)、股动脉穿刺时(T2)、血管内覆膜支架释放时(T3)、手术结束时(T4)的平均动脉压（MAP）、警觉/镇静(OAA/S)评分和脑电双频指数（BIS）。比较3组患者不良反应发生情况。结果 3组患者不同时点MAP组间及组内比较差异均无统计学意义（均P＞0.05）。T1、T2、T3及T4时点各组OAA/S评分差异均有统计学意义（均P＜0.05）。D3组T2、T3及T4时点的OAA/S评分均低于T0时点（均P＜0.05）。T1、T2及T3时点3组BIS差异均有统计学意义（均P＜0.05）。D3组T1、T2、T3及T4时点BIS评分均低于T0时点（均P＜0.05）。D1组体动发生率高于D2组和D3组［35.0%(7/20)比5.0%(1/20)、0(0/20)］（均P＜0.05）。结论 给予0.8 μg/kg负荷量、0.4 μg/（kg·h）维持量的右美托咪定联合舒芬太尼应用于TEVAR手术能取得良好的镇静与镇痛效果，减少体动的发生。

• Objective To investigate anesthetic effect and safety of different doses of dexmedetomidine combined with sufentanil on thoracic endovascular aortic repair (TEVAR). Methods Sixty patients with Stanford type B aortic dissection treated with TEVAR in Beijing Anzhen Hospital, Capital Medical University from December 2018 to August 2019 were selected. According to the random number table method, they were divided into D1 group, D2 group and D3 group, with 20 cases in each group. Before the operation, the three groups were infused with 0.6, 0.8 and 1.0 μg/kg dexmedetomidine within 20 min, sufentanil 0.3 μg/kg was given at the same time intravenous drip slowly, and then pumped dexmedetomidine 0.3, 0.4 and 0.5 μg/（kg·h） continuously until the end of operation. The mean arterial pressure (MAP), observer′s assessment of alertness/sedation (OAA/S) score and bispectral index (BIS) were observed at the time of entry (T0), right radial artery puncture (T1), femoral artery puncture (T2), release of intravascular covered stent (T3), and the end of operation (T4). The adverse reactions were compared among the three groups. Results   There was no significant difference in MAP among the three groups at different time points (all P＞0.05). There were significant differences in OAA/S scores at T1, T2, T3 and T4 among the groups (all P＜0.05). The OAA/S score of D3 group at T2, T3 and T4 was lower than that at T0 (all P＜0.05). There were significant differences in BIS among the three groups at T1, T2 and T3 (all P＜0.05). The BIS score of D3 group at T1, T2, T3 and T4 was lower than that at T0 (all P＜0.05). The incidence of body movement of D1 group was higher than that of D2 group and D3 group［35.0%(7/20) vs 5.0%(1/20), 0(0/20)］(both P＜0.05). Conclusion  Dexmedetomidine given a load of 0.8 μg/kg and a maintenance dose of 0.4 μg/(kg·h) combined with sufentanil can provide good sedative and analgesia effect along with decrease of body movement in TEVAR.