右美托咪定在经股动脉导管主动脉瓣置入术中的应用

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右美托咪定在经股动脉导管主动脉瓣置入术中的应用

翻译：安丽  编辑：冯玉蓉  审校：曹莹

背景：右美托咪定是一种高度选择性的α-2肾上腺素受体激动剂，对GABA受体无任何影响。它的镇静、抗焦虑、镇痛和抗交感神经活性，以及减少阿片类药物用量等作用，使其适用于重症监护室中的短期和长期镇静。我们报告了在经股动脉导管主动脉瓣置入术(TAVI)中，使用右美托咪定替代全身麻醉的经验。

方法：回顾性分析2017年7月至2019年10月间经股动脉TAVI手术中接受右美托咪定输注的高危患者的情况。主要观察指标为血流动力学指标：心率(HR)、平均动脉压(MAP)、呼吸氧饱和度(SPO₂)、pH、动脉血氧分压(PaO₂)、二氧化碳分压(PaCO₂)和镇静程度(Richmond镇静量表，RASS)。次要指标包括转为全身麻醉的频率和需要镇静“抢救性治疗”的情况。记录整个麻醉管理和术中及术后并发症的发生率情况。

结果：共评估85例患者(年龄81.5 8 ± 5.2 3岁，男性36.5%，女性63.5%)。根据胸科外科医生协会预测的死亡风险(STS PROM)，预测高发合并症。患者的血流动力学功能均保持正常。4例患者出现心脏骤停，需行经口气管插管和心肺复苏术。9例患者发生房室传导阻滞。呼吸参数稳定，未出现呼吸暂停、通气不足和低氧血症等情况。所有患者的RASS评分均高于或等于0和1。没有病人需要加用咪唑安定或芬太尼。手术技术操作中，在没有引起的血流动力学并发症的情况下，使用右美托咪定镇静的患者并未观察到需要转为全身麻醉。

结论：在这一系列研究中，右美托咪定用于经股动脉入路的TAVI手术是安全有效的。右美托咪定可能是高危老年患者行经股动脉TAVI手术替代全身麻醉的有效选择。

原始文献来源：Cristiano L, Coppolino F, Donatiello V, et al. Use of Dexmedetomidine in Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) Procedures.[J]. Adv Ther 2020 05;375(5).DOI：10.1007/s12325-020-01342-w.

Use of Dexmedetomidine in Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) Procedures

ABSTRACT

Introduction: Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist without any effect on the GABA receptor. Its sedative, anxiolytic, analgesic, and sympatholytic activities together with opioid-sparing effects make it suitable for short- and long-term sedation in the intensive care setting. We report our experience with dexmedetomidine use during transfemoral transcatheter aortic valve implantation (TAVI) procedure as an alternative to general anesthesia.

Methods: This is a retrospective analysis of high-risk patients undergoing dexmedetomidine infusion for the transfemoral TAVI procedure between July 2017 and October 2019. The primary outcome parameters were hemodynamic: heart rate (HR), mean arterial pressure (MAP); respiratory oxygen saturation (SpO2), pH, partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), and sedation level (Richmond Agitation-Sedation Scale, RASS). The frequency of conversion to general anesthesia and the need for sedative ''rescue therapy’’ were secondary endpoints. We also reported the overall anesthetic management and the incidence of intraand postoperative complications.

Results: Eighty-five patients were evaluated (age 81.58 ± 5.23 years, 36.5% men, 63.5% women). High comorbidity, according to the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM). The patients’ hemodynamic functions were kept normal. Complications such as cardiac arrest occurred in four patients; orotracheal intubation and cardiopulmonary resuscitation were necessary. Atrioventricular block occurred in nine patients. Respiratory parameters were maintained stable. Complications such as apnea, hypoventilation, and hypoxemia did not occur. All patients had RASS scores above or equal to 0 and - 1. No patient required rescue midazolam or fentanyl. No conversion to general anesthesia in patients sedated with dexmedetomidine was observed in the absence of hemodynamic complications caused by the surgical technique.

Conclusion: In this series, sedation with dexmedetomidine for TAVI procedures with femoral access was proven effective and safe. Dexmedetomidine may be a valid alternative to general anesthesia in high-risk older patients undergoing transfemoral TAVI.

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