摘要
目的研究探讨右美托咪定对Stanford A型急性主动脉夹层患者实施孙氏手术后发生谵妄及神经功能失调的影响。方法选取40名在本院实施孙氏手术的急性A型主动脉夹层患者,随机分为右美托咪定组和对照组,其中右美托咪定组20例于麻醉诱导后开始给予1μg/kg右美托咪定,输注10 min。输注后以0.5μg/(kg·h)速率持续微量泵入至手术结束,并在呼吸机控制呼吸期间维持此剂量,脱机后使用时间调整为每日21:00至次日早6:00,直至搬出监护病房。对照组20例则接受同剂量生理盐水处理。记录并对比观察两组患者清醒时间、机械通气时间、ICU持续时间、谵妄发生率及谵妄持续时间;于手术前、术后6 h和24 h检测血清脑损伤蛋白S-100β和神经元特异性烯醇化酶(NSE)水平。结果右美托咪定组患者清醒时间和谵妄发生率并无显著性差别,但其机械通气时间、ICU持续时间和谵妄持续时间却显著降低,且术后血清S-100β和NSE水平较低,结果有统计学差异(P<0.05)。结论急性A型主动脉夹层患者实施孙氏手术中及术后给予右美托咪定可以降低术后谵妄持续时间,减少脑损伤特异指标的表达,缩短机械通气及ICU持续时间,改善患者预后。
Objective To investigate the therapeutic effects of dexmedetomidine on postoperative delirium and neurological dysfunction in patients with acute Stanford type A aortic dissection operated by Sun’s Procedure. Methods 40 patients with Stanford type A aortic dissection underwent Sun’s procedure in our hospital were randomly divided into dexmedetomidine group and control group. Dexmedetomidine group(20 patients) received iv dexmedetomidine 1 μg/kg over 10 min after induction of anesthesia and followed by 0.5 μg/(kg·h) until tracheal extubation. In the second-stage, dexmedetomidine were given from 21:00 to 6:00 the next day until leaving ICU. The control group(20 patients) received the same dose of saline. The arousal time, duration of mechanical ventilation, length of ICU stay, delirium incidence and delirium duration between the two groups were recorded and compared. Blood levels of specific brain injury markers such as S-100β and neuron specific enolase(NSE) were detected at three time points: before operation, 6 h post-operation and 24 h post-operation. Results There was no differerce between the 2 groups in arousal time and delirium incidence. The duration of mechanical ventilation, length of ICU stay and delirium duration were significantly shorter in patients of dexmedetomidine group in comparison with the control group, and the postoperative serum S-100β and NSE levels were significantly lower(P<0.05). Conclusion Our results suggested that intraoperative and postoperative dexmedetomidine administration could reduce postoperative delirium duration, mechanical ventilation and ICU stay. It can also reduce blood specific brain injury markers and improve the quality of recovery for patients with acute Stanford type A aortic dissection operated by Sun’s Procedure.
作者
任超
张勇
梁家立
张波
郑德志
Ren Chao;Zhang Yong;Liang Jiali;Zhang Bo;Zheng Dezhi(Department of Cardiothoracic Surgery,No.960 Hospital of PLA,Jinan 250031,China)
出处
《中国体外循环杂志》
2022年第1期11-14,共4页
Chinese Journal of Extracorporeal Circulation
关键词
右美托咪定
A型主动脉夹层
谵妄
神经功能
孙氏手术
Dexmedetomidine
Type A aortic dissection
Delirium
Neurological dysfunction
Sun’s procedure
