右美托咪定对非体外循环下冠状动脉旁路移植术后患者谵妄的影响

发布时间：2018-07-02 15:21

本文选题：谵妄 + 右美托咪定　；参考：《南京医科大学学报(自然科学版)》2017年07期

【摘要】：目的:研究右美托咪定较丙泊酚是否可以减少非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)后谵妄的发生。方法:行OPCABG的患者300例按随机数字法分为2组,入监护室清醒后,分别给予镇静药物右美托咪定[0.4μg/kg缓慢静推,然后以0.2~0.7μg/(kg·h)泵入]和丙泊酚[25~50μg/(kg·min)泵入]。分别使用CAM-ICU和CAM量表评估患者在监护室和普通病房的谵妄情况。研究主要终点为术后5 d谵妄发生率,次要终点为脱机时间、入住ICU时间和总住院时间。结果:右美托咪定组和丙泊酚组谵妄发生率分别为17/150(11.3%)和31/150(20.7%)(P=0.027),谵妄始发时间分别为第2(1~5)天和第1(1~4)天(P=0.031),持续时间分别为1(1~3)d和2(1~4)d(P=0.04)。谵妄患者拔管时间分别为7.6(5.5~15.3)h和9.4(6.2~52.3)h(P=0.002),ICU入住时间分别为61.2(23~161)h和76.5(21~183)h(P=0.035),总住院时间分别为11(6~31)d和14(7~57)d(P=0.08)。结论:以右美托咪定为基础的镇静较以丙泊酚为基础的镇静方案可以减少OPCABG患者术后谵妄发生率、延迟谵妄始发时间、缩短谵妄持续时间和心脏ICU住院时间。
[Abstract]:Aim: to study whether dexmetomidine can reduce the incidence of delirium after off-pump coronary artery bypass grafting (off-pump coronary artery bypass) compared with propofol. Methods: 300 patients with OPCABG were divided into two groups according to random number method. After waking up in the intensive care unit, they were given the sedative dexmetomidine [0.4 渭 g/kg slowly, then injected with 0.2 渭 g/kg 0.7 渭 g / (kg h)] and propofol [2550 渭 g / (kg min)]. The delirium of patients in ICU and general ward was evaluated by CAM-ICU and CAM scale respectively. The main endpoint of the study was the incidence of delirium 5 days after operation, and the secondary endpoint was weaning time, ICU stay and total hospital stay. Results: the incidence of delirium in dexmetomidine group and propofol group was 17 / 150 (11.3%) and 31 / 150 (20.7%) respectively (P0. 027). The onset time of delirium was 2 (1 / 5) days and 1 (1 / 4) day (P0. 031), respectively. The duration of delirium was 1 (1 / 3) d and 2 (1 / 4) d (P0. 04), respectively. The extubation time of delirium patients was 7.6 (5.5 卤15.3) h and 9.4 (6.2n 52.3) h (P0. 002) respectively. The hospitalization time was 61.2 (23 / 161) h and 76.5 (21 / 183) h (P0. 035), respectively, and the total hospitalization time was 11 (6 / 31) d and 14 (757) d (/ P0.08) respectively. Conclusion: the sedative regimen based on dexmetomide can reduce the incidence of postoperative delirium, delay the onset time of delirium, shorten the duration of delirium and the hospitalization time of cardiac ICU in patients with OPCABG.
【作者单位】：南京医科大学第一附属医院胸心外科;
【基金】：江苏省自然科学基金(BK20151589)
【分类号】：R654.2

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