围术期应用盐酸右美托咪定对心脏手术患者预后影响的研究

发布时间：2018-03-15 00:19

本文选题：盐酸右美托咪定　切入点：心脏外科　出处：《北京协和医学院》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景盐酸右美托咪定在围术期已被广泛应。国外有研究证明围术期应用盐酸右美托咪定可以降低术后至一年的死亡率和并发症。本项研究的目的旨在进一步观察盐酸右美托咪定对心脏外科患者预后的影响。方法选择阜外医院2012年6月至2012年9月进行择期心脏手术的患者1477例为研究对象。根据术中是否使用盐酸右美托咪定分为盐酸右美托咪定组(n=1077)和对照组(n=400),院内终点事件采用多因素logistic回归模型,将研究终点指标作为因变量,患者特征和手术操作变量作为协变量,生存分析采用Kaplan-Meier生存曲线和log rank检验。风险比(HR)采用Cox成比风险回归模型进行比较。为进一步确认结果的可靠性,使用倾向性评分方法匹配使实验组和对照组的病例数各为399例,观察两组患者的院内及术后一年预后。结果在符合入选标准的1477例患者中,盐酸右美托咪定组与对照组相比较,体重指数(25.1±3.46 vs 24.5±3.35,P=0.002)与高血压(53.8% vs 47.5%,P=0.032)有统计学差异,其他因素比较差异均无统计学意义。经协变量校正后院内房颤的发生率盐酸右美托咪定组较对照组明显下降(3.25% vs 6.00%),具有统计学差异(校正后OR 0.57;95%CI 0.33-0.97;P值0.037),经倾向性评分处理后,盐酸右美托咪定组院内房颤的发生率较对照组明显下降(2.50% vs 6.02%),具有统计学差异(P=0.01).与对照组相比较,盐酸右美托咪定组在其他院内至术后一年终点并发症和死亡率均没有显著性差异。结论围术期应用盐酸右美托咪定可以降低术后房颤的发生率,但不能改善心脏外科患者其他并发症和死亡率。
[Abstract]:Background: dexmetidine hydrochloride has been widely used in perioperative period. Foreign studies have shown that dexmetidine hydrochloride can reduce mortality and complications from operation to one year. The purpose of this study is to further study. To observe the effect of dexmetidine hydrochloride on the prognosis of cardiac surgery patients. Methods 1477 patients undergoing elective cardiac surgery from June 2012 to September 2012 in Fuwei Hospital were selected. Toimidine was divided into dexmetidine hydrochloride group (n = 1077) and control group (n = 400). The end point events in hospital were analyzed by multivariate logistic regression model. The end point of the study was regarded as dependent variable, and the patient characteristics and operative variables were covariates. Survival analysis was performed by Kaplan-Meier survival curve and log rank test. The risk ratio was compared with Cox proportional risk regression model. In order to confirm the reliability of the results, The number of patients in the experimental group and the control group were 399 each. The prognosis of the patients in hospital and one year after operation was observed. Results among the 1477 patients who met the inclusion criteria, the dexmetomidine hydrochloride group was compared with the control group. Body mass index (BMI) of 25.1 卤3.46 vs 24.5 卤3.35 P0. 002) was significantly different from that of hypertension 53.8% vs 47.5%. The incidence of atrial fibrillation in the dexmetomidine hydrochloride group was significantly lower than that in the control group by 3.25% vs 6.00% (OR 0.57 95 CI 0.33-0.97 P 0.037) after correction, the incidence of atrial fibrillation in the dexmetomidine hydrochloride group was significantly lower than that in the control group (P = 0.037). The incidence of nosocomial atrial fibrillation in dexmetidine hydrochloride group was significantly lower than that in control group (2.50% vs 6.02%, P < 0.01). There was no significant difference in complications and mortality between other hospitals and one year after operation in dexmetidine hydrochloride group. Conclusion the perioperative use of dexmetidine hydrochloride can reduce the incidence of postoperative atrial fibrillation. But it does not improve other complications and mortality in cardiac surgery patients.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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