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目的研究心房颤动(房颤)导管射频消融术中采用丙泊酚深度镇静的有效性、安全性及对操作过程的影响。方法入选160例房颤患者采用持续静脉注射丙泊酚行深度镇静,同期60例未采用丙泊酚的房颤患者作为对照组。深度镇静先给予负荷量丙泊酚1 mg／kg,然后经左锁骨下静脉持续给予维持剂量,起始维持剂量为药典推荐剂量的中位数8 mg·kg-1·h-1术中根据患者的生理指标每10 min调整剂量一次,直至实现理想深度镇静。理想深度镇静的标准:患者意识及疼痛反应消失,但生命体征稳定,无需呼吸及循环支持。分析丙泊酚剂量的影响因素及深度镇静对操作过程的影响。结果160例患者中,除14例(8．8％)外均实现理想深度镇静,未能实现的主要原因是出现不能耐受的不良反应包括低血压、呼吸抑制、剧烈呛咳。实现理想深度镇静的患者,从开始给药至实现理想深度镇静的平均时间为(30±10)min,平均药物维持剂量为(8±3)mg·kg-1·h-1。单变量分析发现年龄>65岁、体重<50 kg及女性患者为给药剂量的影响因素;多变量分析发现仅年龄及体重影响给药剂量。实现理想深度镇静的患者平均手术时间((180±30)min vs(190±37)min,P=0．04]和平均累计放电时间[(59±16)min vs (66±19)min,P=0．007]显著减少且低于对照组,而肺静脉隔离成功率及并发症发生率两组相似。结论房颤导管射频消融术中采用丙泊酚深度镇静安全有效,可提高手术效率,保证手术的顺利进行。
Objective To investigate the effectiveness, safety and impact of propofol-based deep sedation in radiofrequency catheter ablation of atrial fibrillation (atrial fibrillation). Methods A total of 160 patients with atrial fibrillation were treated with continuous intravenous infusion of propofol and 60 patients with propofol-free atrial fibrillation during the same period as the control group. Deep sedation was first given a dose of propofol 1 mg / kg, and then continued via the left subclavian vein to maintain the dose, the initial maintenance dose for the pharmacopoeia median dose of 8 mg · kg-1 · h-1 intraoperative The patient’s physiological index is adjusted every 10 min until the desired depth of sedation is achieved. Ideal Depth of Sedation Criteria: Patient awareness and pain response disappear, but vital signs are stable without respiratory and circulatory support. Analysis of the influencing factors of propofol dosage and the influence of deep sedation on the operation process. Results The optimal depth of sedation was achieved in 160 patients except 14 patients (8.8%). The main reason for failure was unhealthy adverse reactions including hypotension, respiratory depression and severe cough. The mean time to achieve optimal depth of sedation (30 ± 10) min and mean drug maintenance dose (8 ± 3) mg · kg-1 · h-1 in patients who achieved ideal deep sedation. Univariate analysis found that age> 65 years, body weight <50 kg and female patients for the dosage of factors; multivariate analysis found only age and weight affect the dose. Mean operative time (180 ± 30) min vs (190 ± 37) min, P = 0.04] and mean cumulative discharge time [(59 ± 16) min vs (66 ± 19) min) P = 0.007] were significantly lower and lower than the control group, and the success rate of pulmonary venous isolation and complication rate were similar between the two groups.Conclusion The use of propofol deep sedation during radiofrequency ablation of atrial fibrillation catheter is safe and effective, which can improve the operation efficiency, To ensure the smooth operation.