摘要
目的探讨围手术期使用右美托咪定(dexmedetomidine,Dex)对行心脏手术的老年患者术后谵妄发生率的影响。方法本研究纳入了289例年龄超过60岁接受体外循环心脏手术的患者,根据围手术期Dex的使用分为Dex组和对照组。比较两组患者术后谵妄和其他神经精神状态的发生,以及疾病严重程度和术后3月病死率。结果 Dex组患者术后谵妄的发生率较对照组来说显著降低(14.5%vs 48.8%,P <0.001),但两组之间谵妄的平均持续时间没有显著差异(P=0.087)。Dex组患者的术后焦虑状态显著改善,降为12.8%,显著低于对照组(P <0.001),但对于NMSE评分和POCD的发生,两组没有显著差异(P=0.821和0.657)。两组患者之间的疾病的严重程度之间无显著差异,SOFA、saps2和APACHE评分都比较接近。然而,在术后90 d的随访期内,Dex组有4例患者死亡,而对照组有25例患者死亡,两者具有显著差异(P=0.002,Log-rank P=0.004)。结论Dex是围手术期中显著降低术后谵妄发生率、减轻术后焦虑状态的潜在的有效药物,且无不良反应的发生。
Objective To explore the effect of perioperative dexmedetomidine(Dex) on the incidence of postoperative delirium in elderly patients undergoing cardiac surgery. Methods A total of 289 patients aged over 60 years who underwent cardiopulmonary bypass surgery were enrolled in the study and were divided into the Dex group and the control group according to the perioperative use of Dex. The incidence of postoperative delirium and other neuropsychiatric states, severity of disease, and postoperative mortality at three months were compared between the two groups. Results The incidence of postoperative delirium in the Dex group markedly decreased compared with the control group(14.5% vs 48.8%, P < 0.001);there was no significant difference in average duration of delirium between the two groups(P = 0.087). The postoperative anxiety in the Dex group significantly improved and the incidence decreased to 12.8%, obviously lower than that in the control group(P < 0.001). There were no significant differences in NMSE score and the incidence of POCD(P = 0.821, P = 0.657). The severity of disease in the two groups was not significantly different, and SOFA, saps2 and APACHE scores were similar between the two groups. However, during the 90 d postoperative follow-up period, four patients in the Dex group and 25 patients in the control group died;there was a significant difference between the two groups(P =0.002, Log-rank P = 0.004). Conclusion Dex is a potentially effective drug that can significantly reduce the incidence of postoperative delirium and alleviate postoperative anxiety in the perioperative period, without adverse reactions.
作者
尹茂英
赵玉潮
陈萍
熊莉
Yin Maoying;Zhao Yuchao;Chen Ping;Xiong Li(Department of Anesthesiology,the Second People's Hospital of Yibin&Yibin Branch of West China Hospital of Sichuan University,Yibin,Sichuan,644000,China;Department of Anesthesiology,First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan,650032,China)
出处
《西南国防医药》
CAS
2021年第6期492-496,共5页
Medical Journal of National Defending Forces in Southwest China
基金
昆明医科大学2021年研究生创新基金(21019S)。
关键词
右美托咪定
围手术期
保护
谵妄
心脏手术
dexmedetomidine
perioperative
prevention
delirium
cardiac surgery
