右美托咪定在阵发性室上性心动过速射频消融术中镇静和镇痛的应用

目的:评价右美托咪定在阵发性室上性心动过速(PSVT)经导管射频消融术(RFCA)中镇静和镇痛的效果.方法:将行RFCA的PSVT患者30例随机分成2组:右美托咪定组(Dex组)和0.9%氯化钠注射液组(NS组)各15例.患者均于穿刺部位行局部浸润麻醉.Dex组在局麻前10 min内静脉泵注右美托咪定负荷量1 μg/kg,之后以0.5 μg·kg-1·h-1维持至消融结束;NS组静脉泵注等量0.9%氯化钠注射液.分别记录2组入室时、给负荷量后、诱发心动过速时、有效消融放电60 s、消融终点及术后30 min的平均动脉压(MAP)和心率(HR),消融操作时的视觉模拟评分(VAS)、镇静评分,并记录因疼痛停止操作的次数、围手术期不良反应和患者满意度.结果:Dex组在消融期间MAP、HR和VAS均显著低于NS组(P<0.01);右美托咪定不影响心动过速的诱发,患者在消融期间均保持合适的镇静水平,停药后苏醒迅速,术中因疼痛停止操作的次数显著低于NS组(P<0.01),患者满意度高于NS组(P<0.05).结论:PSVT患者行RFCA术中使用右美托咪定可产生良好的镇静和镇痛效果,减少消融应激造成的血流动力学变化,且停药后苏醒迅速,无呼吸抑制,患者满意度高,但应重视输注负荷量时心动过缓的发生.

The sedative and analgesic effects of dexmedetomidine in patients with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation

Objective:To investigate the sedative and analgesic effects of dexmedetomidine(Dex) in patients with paroxysmal supraventricular tachycardia(PSVT) undergoing radiofrequency catheter ablation(RFCA).Methods:Thirty patients with PSVT undergoing RFCA were randomly assigned to Dex group(n=15) and NS group(n=15).All patients were performed with local infiltration anesthesia at the puncture site.In Dex group, the patients were received Dex on maintenance dose of 0.05 μg·kg-1·h-1 to the end of RFCA procedure followed by loading dose of 1 μg/kg within a 10 min infusion, the patients in NS group were received 0.9% saline with same volume.The parameters including mean arterial pressure(MAP), heart rate(HR), visual analogue scale(VAS), and the observer's assessment of alertness/sedation scale were assessed at different time points.Additionally, the times of stopping procedure because of intolerant pain, peri-operative adverse events and patients' satisfaction were recorded.Results:Compared with NS group, MAP, HR and VAS were significantly decreased in Dex group(P<0.01).Patients in Dex group presented a favorite sedation without troubles in trigging tachycardia and delayed recovery, meanwhile, the times of stopping procedure because of intolerant pain was significantly decreased(P<0.01), and the satisfaction was higher than in NS group(P<0.05).Conclusions:Application of Dex in patients with PSVT undergoing RFCA presents a good sedation and analgesia, alleviates the changes of hemodynamics induced by procedural stress without any delayed recovery and respiratory inhibition, and achieves high satisfaction.However, the occurance of bradycardia should be noticed during loading dose infusion.