右美托咪定在Ⅰ型主动脉夹层患者行全弓置换手术后的镇静效果评估

Sedative Effect of Dexmedetomidine in Patients With Type I Aortic Dissection After Total Arch Replacement Surgery

目的:评估右美托咪定在I型主动脉夹层患者行全弓置换手术后的镇静效果。方法:回顾性分析广州军区广州总医院心脏外科中心2007年至2016年期间主动脉夹层弓部受累并行全弓置换术的患者237例,其中男199例(84.0%),平均年龄(48.79±12.65)岁。根据患者术后监护病房(ICU)使用镇静药物的情况分为两组:右美托咪定组(n=126),予右美托咪定负荷量1μg/kg缓慢推注,之后以0.2~0.7μg/(kg·h)持续泵入;咪达唑仑组(n=111),以咪达唑仑0.05μg/kg静脉推注,继以0.02~0.1 mg/(kg·h)持续泵入。两组患者手术方式相同,比较两组患者机械通气时间、谵妄发生率等指标。结果:与咪达唑仑组比较,右美托咪定组机械通气时间[(3.97±1.28)d vs(4.99±1.58)d]、ICU停留时间[(6.63±1.71)d vs(7.24±2.56)d]均较短;谵妄发生率(8.7%vs 18.9%)及永久性神经功能障碍的发生率(5.65%vs13.5%)也均较低,差异均有统计学意义(P均<0.05)。结论:右美托咪定相较于咪达唑仑而言,能有效缩短Ⅰ型主动脉夹层全弓置换患者的机械通气时间及ICU停留时间,并能明显降低神经系统不良事件发生率,对患者的术后恢复起到良性作用。

Objectives： To evaluate the sedative effect of dexmedetomidine（DEX） in patients with type I aortic dissection（AD） after total arch replacement surgery. Methods： A total of 237 AD patients with arch involvement received total arch replacement were enrolled; there were 199（84.0%） male and the patient＇s mean age was（48.79±12.65） years. Based on post-operative application of sedatives during ICU stay, the patients were divided into 2 groups： DEX group, patients received load dose DEX 1μg/kg by slow intravenous injection, then（0.2-0.7） μg/（kg·h） by continuous infusion, n=126 and Midazolam（MDZ） group, patients received load dose MDZ 0.05μg/kg by slow intravenous injection, then（0.02-0.1） mg/（kg·h） by continuous infusion, n=111. Same surgical method was used in both groups, the mechanical ventilation time, incidence of delirium and other relevant indexes were compared between 2 groups.Results： Compared with MDZ group, DEX group had reduced mechanical ventilation time（3.97±1.28） d vs（4.99±1.58） d and ICU stay time（6.63±1.71） vs（7.24±2.56） d, less incidences of delirium（8.7% vs 18.9%） and permanent dysneuria（5.65% vs 13.5%）, all P〈0.05.Conclusions： Compared with MDZ, DEX may effectively reduce mechanical ventilation time, ICU stay time and the incidence of dysneuria in type I AD patients after total arch replacement surgery; it had positive role for patient＇s recovery.