精准麻醉对心血管手术患者术后谵妄的影响

Effects of precision anesthesia on postoperative delirium in patients undergoing cardiovascular surgery

目的通过比较精准麻醉和传统麻醉在心血管手术中的应用,探讨精准麻醉对患者术后谵妄的影响。方法选择在我院行择期心血管手术患者249例,男167例,女82例,年龄25~84岁,BMI 17~37 kg/m^2,ASAⅡ-Ⅳ级,心功能分级(NYHA)Ⅰ-Ⅳ级。将患者随机分为两组:精准麻醉组(P组)和传统麻醉组(T组),每组125例。P组进行精准的麻醉实施、用药和麻醉管理,T组则采用传统的经验式麻醉管理。记录手术时间、心肺转流(CPB)时间、阻断时间、术中舒芬太尼用量及手术类型。使用ICU意识模糊评估法(CAM-ICU)来评估术后5 d内谵妄发生情况,记录谵妄发生与持续时间。记录术后机械通气时间,ICU住院时间,术后住院时间和总住院费用。结果术后5 d内发生谵妄为30例(12.0%),其中P组为9例(7.2%),T组为21例(16.9%)。与T组比较,P组术后5 d内谵妄发生率明显降低(P<0.05),住院费用明显降低(P<0.01),术后机械通气时间、ICU住院时间、术后住院时间明显缩短(P<0.01)。P组术后二次插管、二次ICU、术后气胸的发生率均低于T组,但两组间差异无统计学意义。结论精准麻醉可以有效降低心血管手术后5 d内的谵妄发生率,同时能减少患者术后机械通气时间和ICU住院时间。

Objective To compared the effect of precision anesthesia and traditional anesthesia in cardiovascular surgery,and to explore the effect of precision anesthesia on the prevalence of postoperative delirium.Methods A total of 249 patients scheduled for cardiovascular surgery,167 males and 82 females,aged 25-84 years,BMI 17-37 kg/m^2,ASA physical statusⅡ-Ⅳ,NYHA gradesⅠ-Ⅳ,were enrolled in this study.They were randomly divided into two groups:a precision anesthesia group(group P,n=125)and a traditional anesthesia group(group T,n=125).Patients in group P were receiving accurate anesthesia implementation,medication and management,whereas patients in group T were treated with traditional anesthetic management based on clinical experience.The following information of patients was recorded:operation time,cardiopulmonary bypass(CPB)time,aortic cross-clamping time,intraoperative sufentanil dosage and operation type.Delirium was assessed with the CAM-ICU during the first 5 postoperative days.The occurrence and duration of delirium were recorded.Ventilation time,ICU length of stay,postoperative hospital length of stay and hospitalization expenses were also recorded.Results The total incidence of delirium within 5 d after operation was 30 cases(12.0%),which 9 cases(7.2%)in group P,and 21 cases(16.9%)in group T.Compared with group T,the incidence of delirium within 5 d after the operation in group P was significantly reduced(P<0.05),patients in group P had lower hospital costs and shorter duration of ventilation,ICU and postoperative hospital stay(P<0.01).The incidence of re-intubation,re-ICU and pneumothorax in group P were lower than group T,however,there was no significant difference between the two groups.Conclusion Precision anesthesia can effectively reduce the incidence of delirium within 5 d after cardiac surgery.Meanwhile it can reduce the time of mechanical ventilation and ICU hospitalization.