加速康复外科理念下右美托咪定用于创伤性脑出血术后患者的效果观察  

Enhanced recovery after surgery concept of dexmedetomidine for postoperative patients with traumatic cerebral hemorrhage

作　　者：徐跃文 王菁 赵晶晶[2] 牛昆仑 姚莉 XU Yuewen;WANG Jing;ZHAO Jingjing(Department of Critical Care Medicine,the Second People's Hospital of Hefei Affiliated to Bengbu Medical College,Hefei 230011,China)

机构地区：[1]蚌埠医学院附属合肥市第二人民医院重症医学科,合肥230011 [2]合肥市第二人民医院重症医学科

出　　处：《临床神经外科杂志》2023年第5期569-574,共6页Journal of Clinical Neurosurgery

基　　金：安徽医科大学校科研基金立项资助项目(2021xkj108)。

摘　　要：目的探讨加速康复外科(ERAS)理念下以右美托咪定为基础的镇痛镇静模式对创伤性脑出血患者术后的临床应用效果及预后影响。方法回顾性收集重症临床科研数据库Ⅳ中2008年—2019年创伤性脑出血术后患者的相关临床资料进行研究,联合使用右美托咪定镇痛镇静的患者记为右美组,未使用者记为非右美组,以28 d全因死亡为主要结局,使用倾向性评分匹配法对两组患者进行匹配,平衡组间协变量,采用多因素Logistic回归进行预后因素分析,采用Kaplan-Meier曲线和Log-rank检验比较总体生存情况。结果共有526例患者被纳入研究,其中右美组163例,非右美组363例,与右美组相比,临床特征方面,非右美组年龄更大,男性比例更多,高血压患者更多,GCS评分更高;实验室检查方面,非右美组入重症监护室时心率较低,凝血酶原时间(PT)、谷丙转氨酶(ALT)及谷草转氨酶(AST)更高;在合并症方面也存在显著差异。使用倾向性评分匹配法,两组共有138对匹配成功,组间协变量经匹配后达到平衡,匹配前,多因素Logistic回归显示,使用右美托咪定是创伤性脑出血患者术后的保护性因素(P<0.05,95%CI=0.191~0.599),OR值较非右美组降低0.662,Kaplan-Meier生存曲线显示非右美组28 d病死率更高,Log-rank检验结果χ^(2)=13.56,P<0.05;匹配后,多因素Logistic回归显示,右美组OR值较非右美组降低0.613(P<0.05,95%CI=0.201~0.745),Kaplan-Meier生存曲线显示非右美组28 d病死率更高,Log-rank检验结果χ^(2)=8.24,P<0.05。结论以右美托咪定为基础的镇痛镇静治疗可降低创伤性脑出血患者术后28 d死亡风险。Objective To investigate the clinical effect and prognostic impact of dexmedetomidine based analgesic sedation mode under enhanced recovery after surgery(ERAS)concept on postoperative patients with traumatic cerebral hemorrhage.Methods Clinical data related to patients with post-traumatic cerebral hemorrhage from 2008 to 2019 in the MIMIC-IV database were retrospectively collected for the study,and patients who were combined with dexmedetomidine analgesic sedation were recorded as the dexamethasone group and non-users as the non-dexamethasone group,with 28-day all-cause death as the primary outcome,and patients in both groups were matched using propensity score matching,balanced between-group covariates,and prognostic factors were analyzed using multifactorial logistic regression,and overall survival was compared using Kaplan-Meier curves and Log-rank tests.Results A total of 526 patients were included in the study,163 in the dexamethasone group and 363 in the non-dexamethasone group.Compared with the dexamethasone group,the clinical characteristics were older,more male,more hypertensive patients,and higher GCS scores in the non-dexamethasone group;in terms of laboratory tests,the non-dexamethasone group had a lower heart rate at ICU admission and higher prothrombin time(PT),alanine transaminase(ALT),and glutathione transaminase(AST)were higher;there were also significant differences in comorbidities.Using propensity score matching,138 pairs were successfully matched between the two groups,and the covariates between groups were balanced after matching.Before matching,multifactorial logistic regression showed that the use of dexmedetomidine was a protective factor after surgery in patients with TBI(P<0.05,95%CI=0.191-0.599),with a lower OR of 0.662 compared with the non-dexmed group.Kaplan-Meier survival curve showed a higher 28-day morbidity and mortality rate in the non-dexamethasone group,Log-rank test resultχ^(2)=13.56,P<0.05;after matching,multifactorial logistic regression showed a 0.613 lower OR in the dex

关 键 词：加速康复外科 右美托咪定 创伤性脑出血 倾向性评分匹配 临床效果 

分 类 号：R743.34[医药卫生—神经病学与精神病学]