右美托咪定和丙泊酚静脉镇静对心脏瓣膜置换患者血流动力学和术后谵妄影响的比较  

Comparison of effects of intravenous sedation by dexmedetomidine and propofol on hemodynamic variables and postoperative outcomes in patients underwent cardiac valve replacement

作　　者：曾庆玲[1] 唐培佳[1] 陈敬祥[1] ZENG Qing-ling;TANG Pei-jia;CHEN Jing-xiang(Yulin First People's Hospital,Yulin,Guangxi 537000,China)

机构地区：[1]玉林市第一人民医院麻醉科,广西玉林537000

出　　处：《岭南心血管病杂志》2020年第3期297-301,共5页South China Journal of Cardiovascular Diseases

基　　金：玉林市科学研究与技术开发计划项目(项目编号:玉市科计20161615)。

摘　　要：目的比较右美托咪定和丙泊酚静脉镇静对心脏瓣膜置换患者血流动力学参数以及术后结果的影响。方法研究采用前瞻随机对照的研究设计,连续入选2016年3月至2017年5月在玉林市第一人民医院就诊的70例年龄>30岁行心脏瓣膜置换手术,并且符合入排标准的患者。在麻醉诱导后,随机接受丙泊酚0.25~1.00 mg/(kg·h)持续泵入或右美托咪定1μg/kg后以0.2~0.6μg/(kg·h)持续泵入。两组采用相同的麻醉技术和生理监测。比较两组患者的血流动力学参数(平均心率及平均动脉压),术中升压或强心药物的使用情况以及院内临床结局,术后气管插管时间,重症监护室时间和术后谵妄的发生率。结果与丙泊酚组患者相比,右美托咪定组患者的平均心率和平均动脉压显著降低,差异有统计学意义(P<0.05)。两组患者升压药和强心药物的使用率相近,差异无统计学意义(P>0.05)。右美托咪定组患者术后机械通气时间和重症监护病房住院时间明显缩短[机械通气时间:(6.4±4.3)h vs.(8.9±4.5)h,P=0.020;重症监护病房停留时间:(115±24.6)h vs.(142±26.9)h,P<0.001]。右美托咪定组患者谵妄风险显著低于丙泊酚组,差异有统计学意义(5.7%vs.22.9%,P=0.040)。结论围术期静脉注射右美托咪定比丙泊酚具有更稳定的血液动力学效应,且可以降低术后谵妄的风险,并缩短患者在重症监护病房的停留时间。Objectives To compare the effects of intravenous sedation by dexmedetomidine and propofol on hemodynamic variables and postoperative outcomes in patients underwent cardiac valve replacement.Methods Seventy patients were randomized to receive either a continuous infusion of propofol[0.25-1 mg/(kg·h)]or dexmedetomidine bolus of 1μg/kg over 10 min followed by infusion[0.2-0.6μg/(kg·h)]after induction of anesthesia.The anesthesia technique and physiological monitoring were similar between the two groups.Hemodynamic variables[mean heart rate(HR),mean arterial pressure(MAP)],application of vasopressors and inotropes during operation,in-hospital clinical outcomes,postoperative ventilation duration,duration of stay in the intensive care unit(ICU)and risk of postoperative delirium were recorded and compared between the two groups.Results HR and MAP were significantly lower in dexmedetomidine group compared to propofol group(P<0.05).Both the groups had a similar requirement of vasopressors and inotropes(P>0.05).Durations of postoperative ventilation and stay in the ICU were significantly shorter in dexmedetomidine group than those in propofol group[duration of postoperative ventilation:(6.4±4.3)h vs.(8.9±4.5)h,P=0.020;duration of stay in the ICU:(115±24.6)h vs.(142±26.9)h,P<0.001].The risk of delirium was significantly lower in dexmedetomidine group than that in propofol group(5.7%vs.22.9%,P=0.040).Conclusions The perioperative infusion of dexmedetomidine produces better hemodynamic stability,reduces the risk of postoperative delirium and leads to shorter duration of ICU stay than propofol dose.

关 键 词：心脏外科手术 右美托咪定 丙泊酚 静脉镇静 血流动力学 术后谵妄 

分 类 号：R654.2[医药卫生—外科学]