右美托咪定术后镇静对行非心脏外科手术的稳定性冠心病患者短期预后的影响

Short-term progmnosis of postoperative sedation with dexmedetomidine in patients with stable coronary heart disease undergoing non-cardiac surgery

目的评价行非心脏手术的稳定性冠心病(SCAD)患者术后应用右美托咪定镇静对住院期间发生不良心脑血管事件(MACCE)的影响。方法回顾性病例对照研究。连续纳入2015年1月至2019年12月在我院诊治的行非心脏手术的SCAD患者,选择60例手术后应用右美托咪定镇静的患者作为观察组,选择年龄、性别、心肺功能匹配的、手术后未应用右美托咪定镇静的60例患者作为对照组。观察并记录两组的基线和围术临床资料。随访观察住院期间的MACCE事件,包括新发心房颤动、心力衰竭、再发心绞痛、谵妄、死亡和急性肾损伤。Kaplan-Meier生存曲线分析两组的MACCE事件情况,Cox回归分析影响MACCE的危险因素。结果120例患者中,男性61例(50.8%),平均年龄为(56.2±20.9)岁。两组的年龄、性别、体质指数、既往病史、心肺功能和治疗等基线资料相似(均为P>0.05)。围术期间,两组苏醒时的心率、呼吸、血压、血氧饱和度均相似(均为P>0.05),但观察组的苏醒时间短(P<0.05),而术后机械通气时间、ICU住院时间和总住院时间两组间无显著差异(均为P>0.05)。平均住院时间为(12.7±3.1)d,观察组的MACCE事件发生率明显低于对照组(6.7%比13.3%,χ^(2)=3.521,P=0.046)。多因素Cox回归分析结果显示,年龄(HR=1.81)、手术时间(HR=1.54)、B型利钠肽(HR=2.47)和脑血管病史(HR=2.65)是影响MACCE发生的危险因素,而右美托咪定是其保护因素(HR=0.58)(均为P<0.05)。结论术后右美托咪定镇静可明显降低稳定性冠心病行非心脏手术患者MACCE的发生,而年龄、手术时间、B型利钠肽和脑血管病史是其危险因素。

Objective To evaluate the effect of dexmedetomidine on adverse cardiac and cerebrovascular events(MACCE)in patients with stable coronary heart disease(SCAD)undergoing non-cardiac surgery.Methods This study was a retrospective case-control study.The patients with SCAD who underwent non-cardiac surgery diagnosed and treated in our hospital from January 2015 to December 2019 were continuously included.A total of 60 patients who were sedated with dexmedetomidine postoperatively were selected as the observation group.After matching the age,gender and cardiopulmonary function,another 60 patients who were not sedated with dexmedetomidine were served as the control group.The baseline and perioperative clinical data of the two groups was recorded.The rate of MACCE events during hospitalization,including new occurrence of arrhythmia,heart failure,recurrent angina,delirium,and acute kidney injury was recorded and compared between the two groups with kaplan-meier survival analyses.Cox regression analysis was used to evaluate the risk factors for MACCE.Results Among the 120 patients,61(50.8%)were male,with an average age of(56.2±20.9)years.The baseline data of age,gender,body mass index,past medical history,cardiopulmonary function and treatment of the two groups were similar(all P>0.05).During the perioperative period,the heart rate,respiration,blood pressure,and oxygen saturation of the two groups were similar when they were awakened,but the time of awakening in the observation group was short(P<0.05).In addition,the incidence of MACCE events in the observation group was significantly lower than that in the control group(P<0.05),while postoperative mechanical ventilation time,ICU hospital stay and total hospital stay were not significantly different between the two groups(all P>0.05).Multivariate Cox regression analysis showed that Age(HR=1.81),operation time(HR=1.54),brain natriuretic peptide(HR=2.47)and history of cerebrovascular disease(HR=2.65)were risk factors affecting the occurrence of MACCE,and dexmedetomidine was its protective factor(HR=0.58)(all P<0.05).Conclusions Postoperative dexmedetomidine sedation can significantly reduce the incidence of MACCE in patients with stable coronary heart disease undergoing non-cardiac surgery.Age,operation time,brain natriuretic peptide and history of cerebrovascular disease are its risk factors,and dexmedetomidine is its protective factor.