不同血管活性药物在缺血性脑卒中合并房颤患者神经介入手术中的应用效果比较

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摘要目的比较多巴胺、去氧肾上腺素与甲氧明应用在缺血性脑卒中合并心房纤颤(AF)患者神经介入手术中的效果。方法选择2013-01至2021-12在火箭军特色医学中心住院的缺血性脑卒中合并AF患者行脑血管内介入手术90例,年龄55～78岁,平均(67.04±5.41)岁,身体质量指数(BMI)19～30 kg/m²,美国麻醉医师学会(ASA)分级Ⅱ-Ⅲ级,将患者随机分为三组(n=30) ,分别为多巴胺组(D组)、去氧肾上腺组(P组)、甲氧明组(M组),每组30例。三组患者在手术开始(T₁)至拉栓成功或支架成功置入前10 min(T₄)期间,分别静脉泵入多巴胺、去氧肾上腺素、甲氧明,使血压范围维持在基础值10%以内。在拉栓成功或支架置入成功后,血压范围不超过基础值低限,防止脑血管开通后缺血再灌注损伤。术中采用FloTrac/Vigileo系统监测患者平均动脉压(MAP)、心率(HR)、心输出量(CO)、系统血管阻力(SVR)、每搏量变异(SVV);记录术中心律失常(不包含AF)和快速AF发生例数并计算两者发生率;记录三组患者平均尿量。结果三组患者T₁~T₄时点MAP、SVR差异无统计学意义;P组和M组T₂、T₃、T₄、T₅ 时HR、CO低于D组,差异有统计学意义(P<0.05);P组(13.3%)和M组(10%)心律失常的发生率低于D组(60%)(P<0.05),P组(0%)和M组(0%)快速AF的发生率低于D组(23.3%)(P<0.05);三组患者平均尿量差异无统计学意义。结论多巴胺、去氧肾上腺素和甲氧明应用在缺血性脑卒中合并AF患者行神经介入治疗术中,均可维持良好的血压,但去氧肾上腺素和甲氧明心律失常的发生率明显低于多巴胺,更安全有效。

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	张树峰
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	闫旭
	李春喜
	刘晋

关键词 ：甲氧明, 去氧肾上腺素, 缺血性脑卒中, 心房纤颤, 神经介入手术

Abstract：Objective To compare the clinical effect of dopamine, phenylephrine and methoxamine on patients with ischemic stroke complicated with atrial fibrillation (AF) undergoing neurointerventional surgery.Methods Ninety patients with ischemic stroke complicated with atrial fibrillation undergoing neurointerventional surgery from charactenstic medical Center of Rocket Army were selected, aged 55～78 years, with an average age (67.04±5.41) years and body mass index (BMI) 19～30kg/m², American Society of Anesthesiologists (ASA) grade Ⅱ-Ⅲ and the patients were randomly divided into three groups (n=30): dopamine group (group D), phenylephrine group (group P) and methoxamine group (group M). Dopamine(5-15 μg/kg/min), phenylephrine(0.4-0.8 μg/kg/min) and methoxamine (0.4-4 μg/kg/min) were pumped intravenously from the beginning of the procedure (T₁) to 10 minutes before successful thrombectomy or stent implantation (T₄). The blood pressure range was maintained within 10% of the baseline value. After successful thrombectomy or stent implantation, the blood pressure should not exceed the lower limit of the basic value to prevent ischemia-reperfusion injury after cerebral vascular opening. FloTrac/Vigileo system was used to monitor mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), systemic vascular resistance (SVR) and stroke volume variation (SVV). The number of intraoperative arrhythmias (excluding AF) and rapid AF were recorded and the incidence of both was calculated. The average urine volume of the three groups was recorded.Results There was no significant difference in MAP or SVR among the three groups at T₁-T₄ (P>0.05). HR and CO in group P and group M were lower than those in group D at T₂, T₃, T₄ and T₅ (P<0.05). The incidence of arrhythmia in group P (13.3%) and group M(10%) was lower than that in group D (60%) (P<0.05). The incidence of rapid AF in group P (0%) and group M (0%) was lower than that in group D (23.3%) (P<0.05). There was no significant difference in the average urine volume among the three groups (P>0.05).Conclusions Dopamine, phenylephrine and methoxamine can maintain good blood pressure in patients with ischemic stroke complicated with atrial fibrillation during neurointerventional therapy, but the incidence of arrhythmia of phenylephrine and methoxamine is significantly lower than Dopamine, so they are safer and more effective.

Key words： methoxamine phenylephrine ischemic stroke atrial fibrillation neurointerventional surgery

收稿日期: 2023-03-27

ZTFLH:

R614.2

通讯作者: 刘晋,E-mail:1381004356@163.com

作者简介: 张树峰,本科学历,主治医师。

引用本文:

张树峰, 张许梅, 刘晶晶, 马玉恒, 闫旭, 李春喜, 刘晋. 不同血管活性药物在缺血性脑卒中合并房颤患者神经介入手术中的应用效果比较[J]. 武警医学, 2023, 34(8): 660-663. ZHANG Shufeng, ZHANG Xumei, LIU Jingjing, MA Yuheng, YAN Xu, LI chunxi, LIU Jin. Comparison of effect of different vasoactive drugs in neurointerventional surgery for patients with ischemic stroke complicated with atrial fibrillation. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(8): 660-663.

链接本文:

http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2023/V34/I8/660

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