右美托咪定对全主动脉弓置换术后重度全身炎性反应综合征的影响  

The Benefit of Dexmedetomidine in Severe Systemic Inflammatory Response Syndrome in Patients Following Total Aortic Arch Replacement

作　　者：李军[1] 杨丽静[1] 王春蓉[1] 石晟[1] 张丛雅 方仲蓉[1] 雷桂玉 王古岩 王越夫[1] LI Jun;Yang Li-jing;Wang Chun-rong;Shi Sheng;Zhang Cong-ya;Fang Zhong-rong;Lei Gui-yu;Wang Gu-yan;Wang Yue-fu(Department of Anesthesiology,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院麻醉科,北京100037 [2]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《中国分子心脏病学杂志》2019年第2期2807-2810,共4页Molecular Cardiology of China

基　　金：国家自然科学基金(81770414)

摘　　要：目的探索术中输注右美托咪定对全主动脉弓置换术患者术后重度全身炎性反应综合征(systemic inflammatory response syndrome, SIRS)及早期临床结局的影响。方法选择我院2013年1月至2015年12月在深低温停循环下行全主动脉弓置换术患者522例,根据术中是否连续输注右美托咪定将患者分为右美托咪定组(dexmedetomidine Group, D)和非右美托咪定组(Non-dexmedetomidine Group, Non-D),其中约474 (90.80%)例患者术中使用右美托咪定。比较两组患者术后短期并发症的发生情况,并采用多因素logistic回归分析术后出现重度SIRS的危险因素。结果术后Non-D组发展为重度SIRS的患者比例明显高于D组,[50%(24/48) vs 29.54%(140/474),P=0.004]。多因素Logistic回归分析显示,术中未使用右美托咪啶是术后重度SIRS的独立危险因素(OR=2.548,95%CI=1.360-4.773,P=0.003)。D组术后需血液滤过支持治疗的患者比例明显少于Non-D组,10.76%(51/472) vs 20.83%(10/48),P=0.038。D组术后死亡率为2.32%(11/472),Non-D组死亡率为2.08%(1/48),P=1.000。D组与Non-D组术后平均机械通气时间(20.0h vs24.5h,P=0.112)、平均ICU停留时间(3.0d vs3.0d,P=0.837)及术后平均住院时间(11.0d vs 11d,P=0.518)均无明显统计学差异。结论右美托咪定的抗炎作用可以降低全主动脉弓置换术后重症SIRS的发生率。Objective To retrospectively investigate the effect of dexmedetomidine on postoperative early complications in adults following total aortic arch replacement, especially severe systemic inflammatory response syndrome(SIRS). Methods We enrolled 522 patients who underwent total aortic arch repair with cardiopulmonary bypass in our hospital from January 2013 till December 2015, of which 474 patients were administrated with dexmedetomidine continuously after anesthesia induction. The incidences of short-term complications were compared between dexmedetomidine group and non-dexmedetomidine group, multivariate logistic regression was performed to find out the predictors of severe SIRS after surgical repair as well. Results The number of patients who suffered postoperative severe SIRS in dexmedetomidine group was significantly greater than that in non-dexmedetomidine group,(50%[24/48] vs 29.54%[140/474], P=0.004). With multivariate logistic regression analysis, it was no administration of dexmedetomidine that could independently predict the onset of postoperative severe SIRS(OR=2.548,95%CI=1.360-4.773, P=0.003). Compared with non-dexmedetomidine group, the percentage of patients supported with hemodialysis was significantly lower in dexmedetomidine group(10.76%[51/472] vs 20.83%[10/48],P=0.038). There was no significance in in-hospital mortality following surgery between dexmedetomidine group and non-dexmedetomidine group,(2.32%[11/472] vs 2.08%[1/48], P=1.000). What's more, there was no significant difference in the length of mechanical ventilation(20.0 h vs 24.5 h, P=0.112), intensive care unit stay(3.0 d vs 3.0 d, P=0.837) or postoperative hospitalization stay(11.0 d vs 11.0 d,P=0.518) between dexmedetomidine group and non-dexmedetomidine group. Conclusion The administration of dexmedetomidine could alleviate the prevalence of severe SIRS in adult patients who undergo total aortic arch repair by its antiinflammatory function.

关 键 词：右美托咪定 全主动脉弓置换术 全身炎性反应综合征 临床结局 

分 类 号：R614[医药卫生—麻醉学]