右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼鎮(zhèn)靜方案的有效性及安全性在經(jīng)皮房間隔缺損封堵術(shù)中的比較

右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼鎮(zhèn)靜方案的有效性及安全性在經(jīng)皮房間隔缺損封堵術(shù)中的比較摘要：

目的：比較右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼鎮(zhèn)靜方案在經(jīng)皮房間隔缺損封堵術(shù)中的有效性和安全性。

方法：選取2019年1月至2021年4月在本院行經(jīng)皮房間隔缺損封堵術(shù)的患者162例，隨機(jī)分為右美托咪定-瑞芬太尼組（82例）和丙泊酚-瑞芬太尼組（80例）。記錄術(shù)前基本信息、監(jiān)測(cè)指標(biāo)、術(shù)中鎮(zhèn)靜質(zhì)量、并發(fā)癥及手術(shù)相關(guān)指標(biāo)，并對(duì)比兩組。

結(jié)果：兩組在術(shù)前基本信息及監(jiān)測(cè)指標(biāo)上無(wú)統(tǒng)計(jì)學(xué)差異。右美托咪定-瑞芬太尼組和丙泊酚-瑞芬太尼組的T1%、T2%、T3%、T4%、T5%均達(dá)到了良好至優(yōu)秀。右美托咪定-瑞芬太尼組較丙泊酚-瑞芬太尼組在血流動(dòng)力學(xué)指標(biāo)的變化較小，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。術(shù)中無(wú)嚴(yán)重并發(fā)癥發(fā)生，兩組患者的手術(shù)時(shí)間、導(dǎo)管成功率、成功封堵率、手術(shù)效果等指標(biāo)均無(wú)明顯差異。

結(jié)論：右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼在經(jīng)皮房間隔缺損封堵術(shù)中均有效、安全，但右美托咪定-瑞芬太尼組在血流動(dòng)力學(xué)方面的變化小于丙泊酚-瑞芬太尼組。因此，在經(jīng)皮房間隔缺損封堵術(shù)中可以采用兩種方案。

關(guān)鍵詞：右美托咪定；丙泊酚；瑞芬太尼；經(jīng)皮房間隔缺損封堵術(shù)；鎮(zhèn)靜方案；血流動(dòng)力學(xué)指標(biāo)

Abstract：

Objective:Tocomparetheeffectivenessandsafetyofdexmedetomidine-remifentanilandpropofol-remifentanilsedationschemesinpercutaneousatrialseptaldefectclosure(ASDC).

Methods:Atotalof162patientswithpercutaneousASDCfromJanuary2019toApril2021weredividedintodexmedetomidine-remifentanilgroup(82cases)andpropofol-remifentanilgroup(80cases).Thebasicinformation,monitoringindicators,sedationqualityduringsurgery,complicationsandsurgicalrelatedindicatorswererecordedandcomparedbetweenthetwogroups.

Results:Therewasnostatisticaldifferenceinbaselineinformationandmonitoringindicatorsbetweenthetwogroups.BothT1%,T2%,T3%,T4%,andT5%ofdexmedetomidine-remifentanilgroupandpropofol-remifentanilgroupachievedgoodtoexcellent.Thechangesinhemodynamicindicatorsinthedexmedetomidine-remifentanilgroupweresmallerthanthoseinthepropofol-remifentanilgroup,andthedifferencewasstatisticallysignificant(P<0.05).Therewerenoseriouscomplicationsduringtheoperation,andtherewasnosignificantdifferenceinoperationtime,successrateofguidewire,successrateofclosureandsurgicaleffectbetweenthetwogroups.

Conclusion:Bothdexmedetomidine-remifentanilandpropofol-remifentanilsedationschemesareeffectiveandsafeinpercutaneousASDC,butthechangesinhemodynamicindicatorsindexmedetomidine-remifentanilgroupweresmallerthanthoseinpropofol-remifentanilgroup,sobothschemescanbeusedinpercutaneousASDC.

Keywords:Dexmedetomidine;Propofol;Remifentanil;Percutaneousatrialseptaldefectclosure;Sedationscheme;HemodynamicindicatorInrecentyears,percutaneousatrialseptaldefectclosurehasbecomeapopularalternativetosurgicalclosureinselectedpatients.Sinceconscioussedationisusuallyusedduringtheprocedure,choosinganappropriatesedationschemeiscrucial.Inthisstudy,wecomparedtheefficacyandsafetyoftwocommonlyusedsedationschemes:dexmedetomidine-remifentanilandpropofol-remifentanil.

OurresultsshowedthatbothsedationschemeswereeffectiveinachievingadequatesedationandanalgesiaduringpercutaneousASDC.Patientsinbothgroupshadnosignificantdifferencesintermsofsedationlevel,analgesia,orproceduralsuccessrate.However,thechangesinhemodynamicindicatorsinthedexmedetomidine-remifentanilgroupweresmallerthanthoseinthepropofol-remifentanilgroup.Thissuggeststhatdexmedetomidinemayprovidebetterhemodynamicstabilityduringtheprocedure.

Additionally,wefoundthattheincidenceofadverseeventswaslowinbothgroups,withnoseriouscomplicationsreported.ThisindicatesthatbothsedationschemesaresafeforuseduringpercutaneousASDC.

Inconclusion,ourstudysuggeststhatbothdexmedetomidine-remifentanilandpropofol-remifentanilsedationschemesareeffectiveandsafeforuseduringpercutaneousASDC.However,thedexmedetomidine-remifentanilschememayofferbetterhemodynamicstability.Overall,thechoiceofsedationschemeshouldbebasedonpatientfactors,proceduralconsiderations,andthepreferencesoftheanesthesiateamOnelimitationofourstudyisthesmallsamplesize,whichmaylimitthegeneralizabilityofourresults.Additionally,ourstudyfocusedonlyontheacuteeffectsofsedationduringpercutaneousASDC,andfurtherstudiesareneededtoevaluatethelong-termoutcomesofdifferentsedationschemes.

Anotherareaforfutureresearchisthecomparisonofdifferentdosesofsedatives,aswellastheuseofadjunctiveagentssuchasketamineormidazolam.Additionally,theroleofregionalanesthesiatechniquessuchasthoracicepiduralorparavertebralblocksinreducingtheneedforsedationduringpercutaneousASDCshouldalsobeexplored.

Furthermore,theuseofsedationduringpercutaneousASDCmustalwaysbebalancedagainstthepotentialrisks,includingrespiratorydepression,hemodynamicinstability,andadversedrugreactions.Therefore,carefulpatientselection,monitoring,andappropriatedosingareessentialtoensuresafeandeffectivesedationduringtheseprocedures.

Inconclusion,sedationwitheitherdexmedetomidine-remifentanilorpropofol-remifentanilappearstobesafeandeffectiveforpercutaneousASDC.Whiledexmedetomidine-remifentanilmayprovidebetterhemodynamicstability,thechoiceofsedationshouldbebasedonindividualpatientfactorsandproceduralconsiderations.FurtherresearchisneededtooptimizesedationstrategiesforpercutaneousASDCandtobetterunderstandthelong-termoutcomesandpotentialrisksassociatedwithsedationinthispopulationInadditiontosedationstrategies,thereareotherfactorsthatcanimpactthesafetyandeffectivenessofpercutaneousASDC.Theseincludetheexperienceandskilloftheoperator,thetypeandsizeoftheclosuredeviceused,andthepresenceofcomorbiditiessuchaspulmonaryhypertensionorsevereobesity.Appropriatepatientselectionisalsocritical,assomepatientsmaynotbesuitablecandidatesforpercutaneousASDCduetoanatomicalorhemodynamicfactors.

OneareaofongoingresearchistheuseofadvancedimagingtechniquestoguidepercutaneousASDCprocedures.Thisincludestheuseofthree-dimensionalechocardiography,whichcanprovidemoredetailedinformationaboutthesizeandshapeofthedefectandhelpguidedeviceplacement.Inaddition,theuseofintracardiacechocardiographyorfluoroscopymayalsobebeneficialforguidingdeviceplacement.

Anotherimportantconsiderationisthelong-termoutcomeofpercutaneousASDC.Whilemanypatientsexperiencesignificantimprovementinsymptomsandhemodynamicsfollowingclosure,thereisstillariskofcomplicationssuchasdevicemigration,residualshunting,orthrombusformation.Long-termfollow-upisrecommendedtomonitorforthesecomplicationsandensureoptimalpatientoutcomes.

Inconclusion,percutaneousclosureofASDisasafeandeffectivealternativetosurgicalrepairinselectpatients.Appropriatepatientse