The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients.
The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients.
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DOI：
10.1053/j.jvca.2016.02.026
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发表时间：
2016-12
影响因子：
2.8
通讯作者：
Liu H
中科院分区：
文献类型：
--
作者：
Cheng H;Li Z;Young N;Boyd D;Atkins Z;Ji F;Liu H
本回顾性研究的目的是探讨围手术期使用右美托咪定（Dex）对老年心脏手术患者预后的影响。回顾性调查。来自单一三级医疗中心的患者。505例（≥65岁）行冠状动脉旁路移植术（CABG）或瓣膜手术、CABG和/或瓣膜手术加其他手术的患者分为2组：283例接受静脉滴注右美托明（Dex）组，222例未接受静脉滴注右美托明（非Dex）组。围术期静脉输注右美托咪唑（0.24 ~ 0.6 μg·kg−1·h−1）于体外循环后开始，术后ICU持续时间< 24小时。对数据进行风险调整，倾向评分加权，并采用多因素logistic回归。主要结局是死亡率。次要结局包括术后卒中、昏迷、心肌梗死、心脏传导阻滞、心脏骤停、谵妄、肾功能衰竭和败血症。围手术期输注Dex显著降低住院死亡率（0.90% vs. 2.83%），校正优势比（OR） 0.099；95%置信区间（CI）为0.030-0.324；P=0.004)和手术死亡率（1.35% vs. 3.18%；调整后OR为0.251；95% CI为0.077-0.813；P=0.021）。围手术期Dex治疗也降低了卒中（0.90%比1.77%；校正OR为0.15；95% CI为0.038-0.590；P=0.007）和谵妄（7.21%比10.95%；校正OR为0.35；95% CI为0.112 -0.578；P<0.0001）的风险。这项研究的结果表明，围手术期使用右美托咪定与老年心脏手术后住院和手术死亡率的降低有关。它还降低了老年患者术后中风和谵妄的发生率。
The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery. Retrospective investigation. Patients from a single tertiary medical center. A total of 505 patients (equal or greater than 65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery, CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not(Non-Dex group). Perioperative Dex intravenous infusion (0.24 to 0.6 μg·kg−1·h−1) initiated after cardiopulmonary bypass and continued for < 24 hours postoperatively in the ICU. Data were risk adjusted, propensity score weighted, and multivariate logistic regression was used. The primary outcome was mortality. Secondary outcomes included postoperative stroke, coma, myocardial infarction, heart block, cardiac arrest, delirium, renal failure and sepsis. Perioperative Dex infusion significantly decreased in-hospital mortality (0.90% vs. 2.83%; adjusted odds ratio (OR), 0.099; 95% confidence interval (CI), 0.030-0.324; P=0.004) and operative mortality (1.35% vs. 3.18%; adjusted OR, 0.251; 95% CI, 0.077-0.813; P=0.021). Perioperative Dex treatment also reduced the risk of stroke (0.90% vs. 1.77%; adjusted OR, 0.15; 95% CI, 0.038-0.590; P=0.007) and delirium (7.21% vs. 10.95%; adjusted OR, 0.35; 95% CI, 0.212-0.578; P<0.0001). Results from this study suggested perioperative use dexmedetomidine was associated with a decrease in in-hospital and operative mortality in elderly patients following cardiac surgery. It also reduced incidence of postoperative stroke and delirium in elderly patients.
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