右美托咪定联合β-受体阻滞剂对急性A型主动脉夹层患者心率控制及早期预后的回顾性研究

Retrospective study on heart rate control and early prognosis of dexmedetomidine combined with beta-blocker in patients with acute type A aortic dissection

目的探讨右美托咪定(Dex)联合β-受体阻滞剂对急性A型主动脉夹层患者的心率(HR)控制及早期预后的影响。方法回顾分析2017年2月至2018年4月急性A型主动脉夹层患者共121例,所有患者均常规使用镇痛、控制血压药物,并予β-受体阻滞剂(艾司洛尔联合口服美托洛尔)控制心率,根据是否使用右美托咪定将患者分为非右美托咪定组(Non-Dex组)52例,右美托咪定组(Dex组)69例。观察两组患者的HR和收缩压(SBP)达标情况、达标后的HR和SBP波动幅度、艾司洛尔使用量、急性肺水肿发生率和早期主动脉夹层破裂发生率(入院3d内)等。结果与Non-Dex组比较,Dex组在干预后1 h的HR即开始降低(P﹤0.05);Dex组3h与6h HR达标率明显高于Non-Dex组(53.22%vs.33.45%,78.24%vs.56.35%,P﹤0.05),且Dex组达标后HR波动幅度更小(P﹤0.05),同时艾司洛尔的使用量明显减少[(3569.34±1201.14)mg vs.(6812.12±1801.04)mg,P﹤0.05];两组患者1h的SBP达标率为73.21%和70.65%,差异无统计学意义,但Dex组在达标后的SBP波动更小(P﹤0.05);Dex组患者入院3d内急性肺水肿和主动脉夹层破裂的发生率分别为10.31%和11.91%,显著低于Non-Dex组的21.23%和23.36%(P﹤0.05)。结论对于急性A型主动脉夹层患者,右美托咪定有助于更快、更有效的控制HR,并使血压控制更平稳,同时减少β-受体阻滞剂用量,降低并发症,提高早期生存率。

Objective To investigate the effect of dexmedetomidine(Dex)combined with beta-blocker on heart rate(HR)control and early prognosis in patients with acute aortic dissection.Methods A retrospective analysis included 121 patients with acute A type aortic dissection from February 2017 to April 2018.All the patients were routinely used for analgesic and antihypertensive drugs,and beta-blockers(esmolol compined with oral metoprolol)were used to control HR.The patients were randomly divided into non-dexmedetomidine(group Non-Dex,n=52)and dexmedetomidine(group Dex,n=69)according to whether applied for dexmedetomidine or not.The rate of HR and SBP,the fluctuation of HR and SBP,the amount of esmolol use’the incidence of acute pulmonary edema and the early rupture of aortic dissection(within 3 days of admission)were observed.Results Compared with group Non一Dex,the HR of group Dex began to decrease at 1 h after intervention(P﹤0.05),and the control rate,of 3 and 6 h in group Dex was significantly higher than that in group Non-Dex(53.22%vs.33.45%,78.24% vs.56.35%,P﹤0.05),and the fluctuation of HR was smaller in the Dex group(P﹤0.05).The amount of esmolol use was significantly reduced[(3569.34±1201.14)mg vs.(6812.12±1801.04)mg,P﹤0.05];There was no significant difference in control rate of SBP between two groups,73.21% and 70.65% respectively,however the SBP fluctuation in the Dex group was less than that in the Non-Dex group(P﹤0.05).The incidence of acute pulmonary edema and early rupture of aortic;dissection within 3d of admission in the Dex group was 10.31% and 11.91%respectively,which were significantly lower than those in group Non-Dex 21.23% and 23.36% respectively(P﹤0.05).Conclusion Dexmedetomidine is useful to control HR more quickly and effectively,reduce the dosage of beta一blocker,and make the control of SBP more stable and improve the early survival rate in patients with acute A type aortic dissection.