精准麻醉对心血管手术患者术后谵妄的影响  

Effects of precision anesthesia on postoperative delirium in patients undergoing cardiovascular surgery

作　　者：高宇晨 王越夫[1] 王剑辉[1] 杜娟[2] 李军[1] 石晟[1] 王春蓉[1] 王苏德娜 田宇 GAO Yuchen;WANG Yuefu;WANG Jianhui;DU Juan;LI Jun;SHI Sheng;WANG Chunrong;WANG Sudena;TIAN Yu(Department of Anesthesiology,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,National Center of Cardiovascular Disease,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉中心,100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人术后恢复室,100037

出　　处：《临床麻醉学杂志》2020年第11期1082-1085,共4页Journal of Clinical Anesthesiology

基　　金：北京市自然科学基金京津冀基础研究合作专项(19JCZDJC65100)。

摘　　要：目的通过比较精准麻醉和传统麻醉在心血管手术中的应用,探讨精准麻醉对患者术后谵妄的影响。方法选择在我院行择期心血管手术患者249例,男167例,女82例,年龄25~84岁,BMI 17~37 kg/m^2,ASAⅡ-Ⅳ级,心功能分级(NYHA)Ⅰ-Ⅳ级。将患者随机分为两组:精准麻醉组(P组)和传统麻醉组(T组),每组125例。P组进行精准的麻醉实施、用药和麻醉管理,T组则采用传统的经验式麻醉管理。记录手术时间、心肺转流(CPB)时间、阻断时间、术中舒芬太尼用量及手术类型。使用ICU意识模糊评估法(CAM-ICU)来评估术后5 d内谵妄发生情况,记录谵妄发生与持续时间。记录术后机械通气时间,ICU住院时间,术后住院时间和总住院费用。结果术后5 d内发生谵妄为30例(12.0%),其中P组为9例(7.2%),T组为21例(16.9%)。与T组比较,P组术后5 d内谵妄发生率明显降低(P<0.05),住院费用明显降低(P<0.01),术后机械通气时间、ICU住院时间、术后住院时间明显缩短(P<0.01)。P组术后二次插管、二次ICU、术后气胸的发生率均低于T组,但两组间差异无统计学意义。结论精准麻醉可以有效降低心血管手术后5 d内的谵妄发生率,同时能减少患者术后机械通气时间和ICU住院时间。Objective To compared the effect of precision anesthesia and traditional anesthesia in cardiovascular surgery,and to explore the effect of precision anesthesia on the prevalence of postoperative delirium.Methods A total of 249 patients scheduled for cardiovascular surgery,167 males and 82 females,aged 25-84 years,BMI 17-37 kg/m^2,ASA physical statusⅡ-Ⅳ,NYHA gradesⅠ-Ⅳ,were enrolled in this study.They were randomly divided into two groups:a precision anesthesia group(group P,n=125)and a traditional anesthesia group(group T,n=125).Patients in group P were receiving accurate anesthesia implementation,medication and management,whereas patients in group T were treated with traditional anesthetic management based on clinical experience.The following information of patients was recorded:operation time,cardiopulmonary bypass(CPB)time,aortic cross-clamping time,intraoperative sufentanil dosage and operation type.Delirium was assessed with the CAM-ICU during the first 5 postoperative days.The occurrence and duration of delirium were recorded.Ventilation time,ICU length of stay,postoperative hospital length of stay and hospitalization expenses were also recorded.Results The total incidence of delirium within 5 d after operation was 30 cases(12.0%),which 9 cases(7.2%)in group P,and 21 cases(16.9%)in group T.Compared with group T,the incidence of delirium within 5 d after the operation in group P was significantly reduced(P<0.05),patients in group P had lower hospital costs and shorter duration of ventilation,ICU and postoperative hospital stay(P<0.01).The incidence of re-intubation,re-ICU and pneumothorax in group P were lower than group T,however,there was no significant difference between the two groups.Conclusion Precision anesthesia can effectively reduce the incidence of delirium within 5 d after cardiac surgery.Meanwhile it can reduce the time of mechanical ventilation and ICU hospitalization.

关 键 词：精准麻醉 术后谵妄 心血管手术 靶控输注 

分 类 号：R614[医药卫生—麻醉学]