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[1]惠康丽,郭章宝,黄书翰,等.右美托咪定和咪达唑仑对前循环大血管闭塞支架取栓术后早期神经功能改善的影响[J].医学研究与战创伤救治(原医学研究生学报),2019,21(01):53-56.[doi:10.3969/j.issn.1672-271X.2019.01.012]
　HUI Kang-li,GUO Zhang-bao,HUANG Shu-han,et al.Effect of dexmedetomidine and midazolam on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(01):53-56.[doi:10.3969/j.issn.1672-271X.2019.01.012]
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右美托咪定和咪达唑仑对前循环大血管闭塞支架取栓术后早期神经功能改善的影响()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第21卷
期数:
2019年01期
页码:
53-56
栏目:
临床研究
出版日期:
2019-01-20

文章信息/Info

Title:
Effect of dexmedetomidine and midazolam on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy
作者:
惠康丽; 郭章宝; 黄书翰; 韩云飞
作者单位：210002南京，东部战区总医院麻醉科（惠康丽）,神经内科（韩云飞）;430022武汉，武汉市第一人民医院神经内科（郭章宝）；400042重庆，陆军军医大学附属大坪医院神经内科（黄书翰）
Author(s):
HUI Kang-li1;  GUO Zhang-bao2;  HUANG Shu-han3;  HAN Yun-fei4
(1.Department of Anesthesiology, General Hospital of Eastern Theater Command, PLA， Nanjing 210002, Jiangsu, China;2. Department of Neurology, Wuhan First People′s Hospital, Wuhan 430022, Hubei, China;3. Department of Neurology, Daping Hospital, Army Military Medical University, Chongqing 400042, China;4. Department of Neurology, General Hospital of Eastern Theater Command, PLA， Nanjing 210002，Jiangsu, China)
关键词:
急性缺血性卒中; 支架取栓术; 轻度镇静; 右美托咪定; 咪达唑仑
Keywords:
acute ischemic stroke; mechanical thrombectomy; conscious sedation; dexmedetomidine; midazolam
分类号:
R743.33
DOI:
10.3969/j.issn.1672-271X.2019.01.012
文献标志码:
A
摘要:
目的 比较右美托咪定和咪达唑仑在前循环大血管闭塞病变急诊支架取栓术的围手术期管理中，对早期神经功能改善的影响。方法 回顾性分析东部战区总医院等3家医院2014年1月至2016年10月期间收治的急性前循环大血管闭塞104例患者的临床资料，按照术中镇静药物选择不同分为咪达唑仑组（49例）和右美托咪定组（55例）。分别给予咪达唑仑和右美托咪定镇静。主要观察指标为24 h后神经功能改善情况，其他次级观察指标包括症状性颅内出血、肺炎、90d功能结局改良Rankin量表（mRS）和病死率等。结果 咪达唑仑组和右美托咪定组患者24h后NIHSS评分改善程度（13.2±5.8 vs 14.2±7.7）、无症状性颅内出血（17.3% vs 22.1%）、症状性颅内出血（6.1% vs 10.9%）、肺炎（34.7% vs 29.1%）、90 d良好功能结局mRS 0~2（40.8% vs 49.1%）、住院期间病死率（24.5% vs 14.5%）及3个月病死率（26.5% vs 16.4%）比较差异均无统计学意义（P＞0.05）。结论 在前循环大血管闭塞病变急诊支架取栓术的围手术期管理中，右美托咪定和咪达唑仑对于患者早期神经功能改善的影响无明显差异。
Abstract:
Objective To assess whether dexmedetomidine is superior to midazolam for early neurological improvement among patients receiving stroke thrombectomy.Methods All acute anterior circulation major vascular occlusion patients admitted between January 2014 and October 2016 were included in this study. All patients were divided into midazolam group (n=49) and dexmedetomidine group（n=55） according to intraoperative sedative drug selection, respectively given calmed by midazolam and dexmedetomidine. The primary endpoint was improvement of neurological function after 24 hours. Other secondary endpoints included pneumonia, 90-day functional outcome mRS, mortality, and symptomatic intracranial hemorrhage.Results Two main endpoints of midazolam group and dexmedetomidine group were listed as below: NIHSS score improvement after 24 h (13.2±5.8 vs 14.2±7.7),asymptomatic intracerebral hemorrhage in several secondary endpoint comparisons (17.3% vs 22.1%) and symptomatic intracranial hemorrhage(6.1% vs 10.9%), pneumonia(34.7% vs 29.1%), and 90 days of good functional outcome mRS 0-2 (40.8% vs 49.1%), hospital mortality (24.5% vs 14.5%) and 3-month mortality (26.5% vs 16.4%) were not statistically significant（P＞0.05）.Conclusion In the perioperative management of emergency stent thrombectomy for large anterior vascular occlusion lesions, there was no significant difference in the effect of dexmedetomidine and midazolam on early neurological improvement in patients.

参考文献/References:

[1]Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med，2015，372（11）:1019-1030.
[2]Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med，2015，372(24):2296-2306.
[3]Lwhagen Hendén P, Rentzos A, Karlsson JE, et al. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: The anstroke trial (anesthesia during stroke) [J]. Stroke，2017，48（6）:1601-1607.
[4]Campbell BCV, van Zwam WH, Goyal M, et al. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: A meta-analysis of individual patient data[J]. Lancet Neurol，2018，17（1）:47-53.
[5]Flexman AM, Donovan AL, Gelb AW. Anesthetic management of patients with acute stroke[J]. Anesthesiol Clin，2012，30（2）:175-190.
[6]Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials[J]. JAMA，2012，307（11）:1151-1160.
[7]Kawazoe Y, Miyamoto K, Morimoto T, et al. Effect of dexmedetomidine on mortality and ventilator-free days in patients requiring mechanical ventilation with sepsis: A randomized clinical trial[J]. JAMA，2017，317（13）:1321-1328.
[8]詹普怡, 吴志云. 右美托咪定复合小剂量瑞芬太尼在日间手术中的应用[J].东南国防医药,2014,16(5) :520-521.
[9]罗伟,孙莹杰,刘晓宇,等. 不同剂量右美托咪定对非体外循环冠状动脉旁路移植术中血流动力学的影响[J].医学研究生学报,2016, 29 (3) :290-294. [1]0]Lyden P, Brott T, Tilley B, et al. Improved reliability of the nih stroke scale using video training. Ninds tpa stroke study group[J]. Stroke，1994，25（11）:2220-2226.[1]1]Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-pa vs. T-pa alone in stroke[J]. N Engl J Med，2015，372（24）:2285-2295.[1]2]Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med，2015，372（11）:1009-1018.[1]3]Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association[J]. Stroke，2018，49（3）:e46-e110.[1]4]Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: A randomized trial[J]. JAMA，2009，301（5）:489-499.[1]5]Afonso J, Reis F. Dexmedetomidine: Current role in anesthesia and intensive care[J]. Rev Bras Anestesiol，2012，62（1）:118-133.[1]6]John S, Somal J, Thebo U, et al. Safety and hemodynamic profile of propofol and dexmedetomidine anesthesia during intra-arterial acute stroke therapy[J]. J Stroke Cerebrovasc Dis，2015，24（10）:2397-2403.[1]7]Barends CR, Absalom A, van Minnen B, et al. Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety[J]. PLoS One，2017，12:e0169525.

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更新日期/Last Update: 2019-01-20