目的:探讨盐酸右美托咪定复合芬太尼麻醉对高血压脑出血患者行微创抽吸术中镇静效果及预后的影响。方法:选取2014年1月至2016年2月于洛阳市第一人民医院行微创抽吸术治疗的64例高血压脑出血患者,通过随机数字表法分组,各32例。对照组联...目的:探讨盐酸右美托咪定复合芬太尼麻醉对高血压脑出血患者行微创抽吸术中镇静效果及预后的影响。方法:选取2014年1月至2016年2月于洛阳市第一人民医院行微创抽吸术治疗的64例高血压脑出血患者,通过随机数字表法分组,各32例。对照组联合采用丙泊酚及芬太尼实施麻醉,研究组联合采用盐酸右美托咪定及芬太尼实施麻醉。统计对比术中两组镇静效果、不良反应发生率、入院时及6个月后日常生活能力评分(quality of life,QOL)变化情况。结果:研究组镇静良好率(87.50%)高于对照组(62.50%),差异有统计学意义(P<0.05);研究组恶心呕吐率(3.13%)、心动过速率(6.25%)、低血压率(0.00%)、躁动率(9.38%)低于对照组(25.00%、28.12%、21.88%、37.50%),差异有统计学意义(P<0.05);治疗前两组QOL评分比较,差异无统计学意义(P>0.05),术后研究组QOL评分高于对照组,差异有统计学意义(P<0.05)。结论:盐酸右美托咪定复合芬太尼麻醉效果良好,可提高高血压脑出血患者微创抽吸术中镇静效果,改善预后,且安全性较高。展开更多
The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator （rt-PA） on perihematomal edema （PHE） development in patients with intracerebral hemorrhage （ICH） treated with ...The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator （rt-PA） on perihematomal edema （PHE） development in patients with intracerebral hemorrhage （ICH） treated with minimally invasive surgery （MIS） and the effects of intraclot rt-PA on the 30-day survival. We reviewed the medical records of ICH patients undergoing MIS between October 2011 and July 2013. A volumetric analysis was done to assess the change in PHE and ICH volumes at pre-MIS （T1）, post-MIS （T2） and day 10-16 （T3） following diagnostic computed tomographic scans （To）. Forty-three patients aged 52.8±11.1 years with （n=30） or without rt-PA （n=13） were enrolled from our institutional ICH database. The median rt-PA dose was 1.5 （1） mg, with a maximum dose of 4.0 mg. The ratio of clot evacuation was significantly increased by intraclot rt-PA as compared with controls （77.9%±20.4% vs. 64%±15%; P=0.046）. From TI to T2, reduction in PHE volume was strongly associ- ated with the percentage of clot evacuation （p=0.34; P=-0.027）. In addition, PHE volume was positively correlated with residual ICH volume at the same day （p ranging from 0.39-0.56, P〈0.01）. There was no correlation between the cumulative dose of rt-PA and early （T2） PHE volume （p=0.24; P=0.12） or de- layed （T3） PHE volume （p=0.19; P=0.16）. The 30-day mortality was zero in this cohort. In the selected cohort of ICH patients treated with MIS, intraclot rt-PA accelerated clot removal and had no effects on PHE formation. MIS aspiration and low dose of rt-PA seemed to be feasible to reduce the 30-day mor- tality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed.展开更多
文摘目的:探讨盐酸右美托咪定复合芬太尼麻醉对高血压脑出血患者行微创抽吸术中镇静效果及预后的影响。方法:选取2014年1月至2016年2月于洛阳市第一人民医院行微创抽吸术治疗的64例高血压脑出血患者,通过随机数字表法分组,各32例。对照组联合采用丙泊酚及芬太尼实施麻醉,研究组联合采用盐酸右美托咪定及芬太尼实施麻醉。统计对比术中两组镇静效果、不良反应发生率、入院时及6个月后日常生活能力评分(quality of life,QOL)变化情况。结果:研究组镇静良好率(87.50%)高于对照组(62.50%),差异有统计学意义(P<0.05);研究组恶心呕吐率(3.13%)、心动过速率(6.25%)、低血压率(0.00%)、躁动率(9.38%)低于对照组(25.00%、28.12%、21.88%、37.50%),差异有统计学意义(P<0.05);治疗前两组QOL评分比较,差异无统计学意义(P>0.05),术后研究组QOL评分高于对照组,差异有统计学意义(P<0.05)。结论:盐酸右美托咪定复合芬太尼麻醉效果良好,可提高高血压脑出血患者微创抽吸术中镇静效果,改善预后,且安全性较高。
基金supported by grants from the National Natural Science Foundation of China(No.81171089 and No.30770751)Key Clinical Program of the Ministry of Health of China(2010)the Future Program of New Technology and New Business in Tongji Hospital,China(2012)
文摘The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator （rt-PA） on perihematomal edema （PHE） development in patients with intracerebral hemorrhage （ICH） treated with minimally invasive surgery （MIS） and the effects of intraclot rt-PA on the 30-day survival. We reviewed the medical records of ICH patients undergoing MIS between October 2011 and July 2013. A volumetric analysis was done to assess the change in PHE and ICH volumes at pre-MIS （T1）, post-MIS （T2） and day 10-16 （T3） following diagnostic computed tomographic scans （To）. Forty-three patients aged 52.8±11.1 years with （n=30） or without rt-PA （n=13） were enrolled from our institutional ICH database. The median rt-PA dose was 1.5 （1） mg, with a maximum dose of 4.0 mg. The ratio of clot evacuation was significantly increased by intraclot rt-PA as compared with controls （77.9%±20.4% vs. 64%±15%; P=0.046）. From TI to T2, reduction in PHE volume was strongly associ- ated with the percentage of clot evacuation （p=0.34; P=-0.027）. In addition, PHE volume was positively correlated with residual ICH volume at the same day （p ranging from 0.39-0.56, P〈0.01）. There was no correlation between the cumulative dose of rt-PA and early （T2） PHE volume （p=0.24; P=0.12） or de- layed （T3） PHE volume （p=0.19; P=0.16）. The 30-day mortality was zero in this cohort. In the selected cohort of ICH patients treated with MIS, intraclot rt-PA accelerated clot removal and had no effects on PHE formation. MIS aspiration and low dose of rt-PA seemed to be feasible to reduce the 30-day mor- tality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed.
