| 摘要: |
| 目的 探讨右美托咪定对Stanford A型主动脉夹层行全脉弓人工血管置换术后谵妄的影响. 方法 选取2015年6月至2017年6月我院收治的Stanford A型主动脉夹层且行全脉弓人工血管置换术患者117例,利用随机数字表分为随机分为右美托咪定组(n=59)和丙泊酚组(n=58),两组患者采用相同的麻醉和手术方法,入ICU后,右美托咪定组采用右美托咪定0.40～0.80μg/kg.h静脉泵入,至患者拔管前30min停用,丙泊酚组则给予丙泊酚25～40μg/kg.min泵入,于拔管前2h停用,所有患者于术后第1d开始,采用重症监护意识模糊评估(CAM-ICU)量表评估患者谵妄发生情况及持续时间,记录两组患者二次插管率、机械通气时间、ICU停留时间、总住院时间、低血压发生率、心动过缓发生率和恶心/呕吐发生率。结果 两组患者二次插管率、低血压发生率、心动过缓发生率、恶心/呕吐发生率及RASS评分差异无统计学意义(P>0.05)；右美托咪定组机械通气时间[(4.05±1.18)vs(5.03±1.78)d]、停药后唤醒时间[(34.29±8.32)vs(57.90±10.00)min]、ICU停留时间[(6.63±1.40)vs(7.40±2.00)d]、总住院时间[(29.75±7.49)vs(32.81±7.15)d]、谵妄发生率[13.56% vs 25.86%]和谵妄持续时间[(21.55±5.60)vs(35.42±7.48)h]均低于丙泊酚组,而谵妄始发时间[(2.53±1.36)vs(1.74±0.94)d]高于丙泊酚组,差异有统计学意义(P<0.05)。结论 右美托咪定相比于丙泊酚,可减少Stanford A型主动脉夹层行全脉弓人工血管置换术后机械通气时间和ICU停留时间,降低谵妄发生率,缩短患者总住院时间。 |
| 关键词: Stanford A型主动脉夹层 全脉弓人工血管置换术 右美托咪定 丙泊酚 谵妄 |
| DOI： |
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| 基金项目:河南省医学科技攻关项目 |
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| Effect of dexmedetomidine on postoperative delirium in patients with Stanford type A aortic dissection undergoing total arch replacement surgery |
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caobaojiang
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Henan Provincial People''s Hospital
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| Abstract: |
| Objective To investigate the effect of dexmedetomidine on postoperative delirium in patients with Stanford type A aortic dissection undergoing total arch replacement surgery. Methods A total of 117 cases of patients with Stanford type A aortic dissection undergoing total arch replacement surgery from June 2015 to June 2017 in our hospital were selected. All patients were randomly divided into dexmedetomidine group (n=59) and propofol group (n=58) by using random number table. The same anesthesia and surgical approaches were used in the two groups. After entering the ICU, the patents in the dexmedetomidine group were intravenously administered with dexmedetomidine 0.40 to 0.80 μg/kg?h, while in the propofol group were given propofol 25-40 μg/kg?min. All patients began to assess the occurrence and duration of the time by using the Intensive Care Awareness Fuzzy Assessment (CAM-ICU) scale on the 1st postoperative day. Secondary intubation rate, mechanical ventilation time, ICU stay time, total hospital stay, incidence of hypotension, incidence of bradycardia, and incidence of nausea/vomiting were recorded in the two groups. Results The differences of the rate of secondary intubation, incidence of hypotension, incidence of bradycardia, incidence of nausea/vomiting and RASS score between the two groups were no statistically significant (P>0.05). The mechanical ventilation time [(4.05±1.18) vs (5.03±1.78) d], wake-up time after drug withdrawal [(34.29±8.32) vs (57.90±10.00) min], ICU stay time [(6.63) ±1.40) vs (7.40±2.00) d], total hospital stay [(29.75±7.49) vs (32.81±7.15) d], the incidence of delirium [13.56% vs 25.86%] and the duration of delirium [(21.55±5.60) vs (35.42±7.48) h] in the dexmedetomidine group were lower than the propofol group, while the time of onset of delirium [(2.53±1.36) vs (1.74±0.94) d] was higher than the propofol group, the differences were statistically significant (P<0.05). Conclusion Compared with propofol, dexmedetomidine can reduce mechanical ventilation time and ICU stay time in patients with Stanford type A aortic dissection after total arch replacement surgery, reduce the incidence of delirium and shorten the total hospital stay. |
| Key words: Stanford type A aortic dissection total arch replacement surgery dexmedetomidine propofol delirium |
