颈动脉狭窄患者血管内支架成形术中麻醉药物的应用

目的探讨颈动脉狭窄患者血管内支架成形术(PTAS)中神经安定镇痛麻醉药物的应用和术中管理。方法颈动脉狭窄患者行PTAS 174例,获得知情同意后分为神经安定镇痛麻醉组(观察组,106例)和单纯局部麻醉组(对照组,68例)。观察两组患者入手术室、股动脉穿刺、球囊扩张、支架置入和术毕时血压、心率、脉搏氧饱和度(SPO2)的变化;对患者意识进行Ramsay镇静分级;记录两组血管活性药物的使用情况。结果支架置入成功率为99.4%;观察组Ramsay镇静分级多在Ⅱ~Ⅳ级(90.6%),对照组多在Ⅰ级(91.2%);两组患者SPO2均高于90%;观察组股动脉穿刺时收缩压与入手术室时比较明显降低(P<0.05);观察组行股动脉穿刺时收缩压与对照组比较明显降低(P<0.05);观察组血管活性药物的使用(51.1%)低于对照组(69.5%,P<0.05)。结论在PTAS中维持患者适宜的镇静程度,有利于维持循环稳定,并减少血管活性药物的使用,是保障手术成功和减少手术并发症发生的关键因素之一。

Anesthesia for percutaneous transluminal angioplasty and stenting in stenosis of carotid artery

Objective To explore use of sedatives and analgesics in the operation of percutaneous transluminal angioplasty and stenting(PTAS) for treatment of carotid stenosis.Methods With the consent of the patients,174 cases underwent this procedure in our hospital.They were assigned to sedative anesthesia group(observing group,106 cases) and local anesthesia group(control group,68 cases).Blood pressure,heart rate,pulse oxygen saturation(SPO2) and the consciousness(Ramsay scale) of all patients were recorded at the time of entering the operation room,puncture of femoral artery,expanding by balloon,stent implanting and operation end.The use of vasoactive agents was also recorded.Results The successful cases of PTAS was 173(99.4%).Most of the observing cases were rated as Ramsay grades Ⅱ-Ⅳ(90.6%),and most of the control cases were grade Ⅰ(91.2%).No hypoxemia happened.There was significant decrease in systolic blood pressure in observing group at the time of femoral artery puncture compared with that in control group(P<0.05).The use of vasoactive agents in observing group (51.1%) was less than that in the control group(69.5%,P<0.05).Conclusions In PTAS the use of anesthetic drugs can guarantee the sedation of patients and reduce the use of vasoactive agents.It is one important factor that guarantees the success of operation and decrease in complication.