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中国临床研究:2021,34(10):1384-1387
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不同麻醉方式在下肢动脉硬化闭塞症合并心力衰竭微创完全血运重建中的应用
(1. 丹东市第一医院麻醉科,辽宁 丹东 118000;2. 辽宁中医药大学附属医院,辽宁 沈阳 110000)
Application of different anesthesia methods in minimally invasive total revascularization for lower extremity arteriosclerosis obliterans complicated with heart failure
摘要
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投稿时间:2021-01-31   网络发布日期:2021-10-22
中文摘要: 目的 探讨在下肢动脉硬化闭塞症(LEAOD)合并心力衰竭(心衰)患者实施药物涂层球囊(DCB)介入术麻醉中右美托咪定联合羟考酮应用的有效性及安全性。 方法 选择2017年5月至2019年5月行DCB介入治疗的股浅动脉闭塞症合并心衰患者,采用完全随机1∶1方式分为试验组(羟考酮+右美托咪定)63例,对照组(芬太尼+右美托咪定)63例,观察两组患者围术期 不同时点[静脉麻醉后置管前10 min(T1)、股动脉穿刺后(T2)、完成球囊扩张时(T3)、撤出导丝单独留置鞘管时(T4)]的 MAP、HR和SpO2、手术情况、不良反应及术后6个月下肢缺血改善情况。结果 MAP、SpO2及HR在T2、T3改变明显,与T1相比大多差异有统计学意义( P <0.05); 除T3的MAP外,在T2、T3两组的MAP、SpO2及HR差异有统计学意义( P <0.05)。试验组T3的VAS评分优于对照组,且术毕至出恢复室观察时间短于对照组( P <0.01)。随访6个月,两组踝肱指数高于治疗前,且试验组高于对照组( P <0.01)。两组全程手术时间、出室Ramsay评分、术前术后NT-proBNP水平及术后6个月的Rutherford分级改善情况相近( P >0.05)。 结论 围术期中,羟考酮+右美托咪定对于LEAOD合并心衰患者麻醉效果确切,可明显抑制疼痛,提高手术质量,对心功能及6个月下肢缺血改善情况无负面影响。
Abstract:Objective To investigate the efficacy and safety of dexmedetomidine and oxycodone during drug-coated balloon (DCB) interventional anesthesia in patients with lower extremity arteriosclerosis obliterans complicated with heart failure(HF). Methods The patients with superficial femoral artery occlusion complicated with HF treated with DCB therapy from May 2015 to May 2019 were randomly divided into experimental group (dexmedetomidine with oxycodone, n =63) and control group (fentanyl with dexmedetomidine, n =63). MAP, HR and SpO2 in perioperative period [ten minutes before catheterization (T1), after femoral artery puncture (T2), completion of balloon dilatation (T3), withdrawal of guide wire and indwelling of sheath (T4)], operation condition, adverse reaction and evaluation of lower limb ischemia 6 months after operation were observed between two groups. Results MAP, SpO2 and HR changed significantly in T2 and T3, and most of the differences were statistically significant compared with T1 ( P <0.05). Except for MAP of T3, there were significant differences in MAP, SpO2 and HR between the two groups at T2 and T3 ( P <0.05). VAS score in experimental group was better than that in control group, and the recovery time of consciousness after operation was significantly shorter than that in control group( P <0.01). During 6 months of follow-up after operation, ankle-brachial index (ABI) was higher than that before treatment in both groups and was higher in experimental group than that in control group ( P <0.01). There was no statistical difference in the total operation time, Ramsay sedation score, NT-proBNP level before and after surgery, and Rutherford grades at 6 months after operation between two groups ( P >0.05). Conclusions In the perioperative period of DCB therapy,the anesthesia effect of oxycodone and dexmedetomidine is exact and can obviously reduce operative pain and have no negative impacts on cardiac function and 6-month lower limb ischemia.
文章编号:     中图分类号:R541.4    文献标志码:B
基金项目:辽宁省沈阳市科技计划项目
引用文本:
李娟,季康寿,姜钧文.不同麻醉方式在下肢动脉硬化闭塞症合并心力衰竭微创完全血运重建中的应用[J].中国临床研究,2021,34(10):1384-1387.

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