摘要
目的观察右美托咪定监护下麻醉(MAC)用于经颈静脉肝内门体静脉分流术(TIPS)的麻醉效果。方法4 0例拟行TIPS的患者随机分为右美托咪定组(D组,n=20)和丙泊酚组(P组,n=20),D组和P组首先分别给予负荷剂量的右美托咪定和丙泊酚,然后调整两组的给药剂量使Ramsay镇静评分维持于2~4分,两组患者术前均给予0.1μg/kg的舒芬太尼,且术中酌情追加0.05μg/kg每次。记录麻醉前(T0)、手术开始前(T1)、球囊扩张时(T2)、支架植入时(T3)、术毕(T4)时的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2),舒芬太尼用量、呼吸抑制发生例数、手术时间、清醒时间等。结果 MAP:T1时,P组较D组明显下降(P<0.05);T2、T3时,P组的MAP较D组明显升高(P<0.05);HR:T3时,P组较D组明显升高(P<0.05);SPO2:T1、T2、T4时,P组较D组明显降低(P<0.05);P组的苏醒时间长于D组(P<0.05);P组的舒芬太尼用量、呼吸抑制的发生例数较D组高(P<0.05)。结论右美托咪定行MAC用于TIPS术安全可行。
Objective To observe the application of monitored anesthesia care （MAC） with dexmedetomidine （DEX） in transjugular in- trahepatic portosystemic shunt （TIPS）. Methods Forty patients undergoing TIPS were randomly divided into the DEX group （ group D, n = 20） and propofol group （ group P, n = 20 ）. Initial loading dose of DEX and pmpofol were respectively given in group D and group P, and then Ramsay sedation score was maintained 2 -4 points by adjusting the dose of DEX and propofol. 0.1 t^g/kg sufentanil was given before operation, and O. 05 p,g/kg was additional administrated according to intraoperative conditions in both groups. MAP, HR, SPO2 were recorded at five time points： be- fore anesthesia （ To ）, before operation （ Tl ）, during balloon dilating （ T2 ）, during stentt dilating （ T3 ）, when operation finished （ T4 ）. The total dosage of sufentanil, the cases of respiratory depression, the duration of operation and recovery time were also recorded. Results The MAP in group P at the time of T1 was significantly lower but it was significantly higher at the time of T2 , and T3 than that in group D （ P 〈0.05 ）. The HR in group P at the time of T3 was significantly higher than group D （ P 〈 O. 05 ）. The SPO2 in group P at the time of Tl , T2 and T4 was signifi- cantly lower than that in group D （ P 〈 0.05 ）. The recovery time in group P was significantly longer than group D （ P 〈 O. 05 ）. The total dosage of sufentanil and the cases of respiratory depression in group P were significantly higher than group D （ P 〈 0.05 ）. Conclusion DEX for MAC in TIPS is safe and feasible.
出处
《临床和实验医学杂志》
2015年第11期946-949,共4页
Journal of Clinical and Experimental Medicine
关键词
经颈静脉肝内门体静脉分流术
右美托咪定
监护下麻醉
Transjugular intrahepatic portosystemic shunt
Dexmedetomidine
Monitored anesthesia care
