Department of Intensive Care Unit, the First Affiliate Hospital, Fujian Medical University, Fuzhou, 350004, Fujian Province, People's Republic of China.
Anesthesiology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian Province, People's Republic of China.
J Cardiothorac Surg. 2022 May 3;17(1):100. doi: 10.1186/s13019-022-01834-6.
The study was aimed to compare the efficacy and safety of different sedation protocols of dexmedetomidine-remifentanil and propofol-remifentanil for percutaneous closure of atrial septal defects (ASD) under transthoracic echocardiography (TTE) guidance.
From March 2020 to January 2021, of 114 patients screened, 59 ASD patients scheduled for percutaneous closure under TTE guidance were randomly allocated into the dexmedetomidine-remifentanil (D-R) group (n = 29) and the propofol-remifentanil (P-R) group (n = 30). The incidence of hemodynamic and respiratory adverse events, arterial blood gas analysis, induction and recovery time, pain score, infusion rate of remifentanil, satisfaction of the surgeon and patient, additional sedatives were collected for analysis and comparison.
The induction time was longer in the D-R group than that in the P-R group (17.66 ± 2.65 min vs 11.43 ± 1.48 min; difference, 6.22 min; 95% CI 5.10 to 7.35; P < 0.001). No differences were observed in the 2 groups in terms of the additional sedatives, infusion rate of remifentanil, pain score, recovery time (P > 0.05). There was no difference between the two groups regarding the incidence of cardiovascular adverse events (6 [20.7%] vs 4 [13.3%]; difference, 7.4%; 95% CI - 11.7 to 26.5%; P = 0.506). Respiratory adverse events occurred in 1 patient (3.4%) in the D-R group, and 8 patients (26.7%) in the P-R group (difference, 23.3%; 95% CI 6.2 to 40.5%; P = 0.026). The incidence of hypercapnia was significantly lower in the D-R group (4 [13.8%]) than in the P-R group (13 [43.3%]; difference, 29.5%; 95% CI 7.8 to 51.2%; P = 0.012).
Except for more rapid the induction time and higher the surgeon satisfaction score in the propofol-remifentanil protocol, the efficacy was similar between two sedation protocols. The hemodynamic stability was comparable, the dexmedetomidine-remifentanil protocol had superior airway security due to fewer hypercapnia and respiratory adverse events.
本研究旨在比较右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼两种不同镇静方案在经胸超声心动图（TTE）引导下经皮房间隔缺损（ASD）封堵术的疗效和安全性。
2020 年 3 月至 2021 年 1 月，在筛选出的 114 名患者中，59 名拟在 TTE 引导下经皮 ASD 封堵术的患者被随机分为右美托咪定-瑞芬太尼（D-R）组（n=29）和丙泊酚-瑞芬太尼（P-R）组（n=30）。收集并分析比较两组患者血流动力学和呼吸不良事件、动脉血气分析、诱导和恢复时间、疼痛评分、瑞芬太尼输注率、术者和患者满意度、辅助镇静剂的使用情况。
D-R 组的诱导时间长于 P-R 组（17.66±2.65 min 比 11.43±1.48 min；差值，6.22 min；95%置信区间 5.10 至 7.35；P<0.001）。两组患者的辅助镇静剂使用、瑞芬太尼输注率、疼痛评分、恢复时间差异无统计学意义（P>0.05）。两组心血管不良事件发生率无差异（6[20.7%]比 4[13.3%]；差值，7.4%；95%置信区间-11.7 至 26.5%；P=0.506）。D-R 组发生呼吸不良事件 1 例（3.4%），P-R 组发生 8 例（26.7%）（差值，23.3%；95%置信区间 6.2 至 40.5%；P=0.026）。D-R 组高碳酸血症发生率明显低于 P-R 组（4[13.8%]比 13[43.3%]；差值，29.5%；95%置信区间 7.8 至 51.2%；P=0.012）。
除丙泊酚-瑞芬太尼方案诱导时间更快、术者满意度评分更高外，两种镇静方案的疗效相似。两种方案的血流动力学稳定性相当，由于高碳酸血症和呼吸不良事件发生率较低，右美托咪定-瑞芬太尼方案具有更好的气道安全性。
