目的:术后谵妄(POD),尤其是在体外循环(CPB)心脏手术后,是一种相对常见和严重的并发症,增加副作用,住院时间,死亡率和医疗资源成本。本研究旨在确定在CPB初期使用甘露醇血清对预防冠状动脉搭桥手术患者谵妄发生的影响。
方法:本研究是单中心,双盲,随机化,于2022年12月至2023年5月进行的对照试验。接受择期冠状动脉搭桥手术的年龄在18-70岁的患者被纳入研究。在对照组(n=45)中,主要溶液包括林格氏乳酸血清。在干预组(n=45)中,主要溶液由200mL甘露醇血清和林格氏乳酸血清组成。该研究的主要结果是POD的发生率。次要结果包括机械通气的持续时间,重症监护病房(ICU)住院时间和30天住院死亡率.
结果:对照组和干预组的人口统计学特征和危险因素差异无统计学意义(p<0.05)。然而,干预组POD发生率明显低于对照组(22.25%vs42.2%,p=0.035)。两组CPB时间无明显差异。主动脉交叉钳夹时间,机械通气时间和ICU住院时间(p<0.05)。此外,死亡率和返回手术室的比率在两组之间没有显著差异(p<0.05).
结论:这项研究得出结论,在CPB泵的灌注中添加甘露醇有助于降低心脏手术后谵妄的发生率。
背景:IRCT20221129056660N1。
OBJECTIVE: Postoperative delirium (POD), especially after cardiac surgery with cardiopulmonary bypass (CPB), is a relatively common and severe complication increasing side effects, length of hospital stay, mortality and healthcare resource costs. This
study aimed to determine the impact of using mannitol serum in the prime of CPB for preventing the occurrence of delirium in patients undergoing coronary artery bypass surgery.
METHODS: This
study is a single-centre, double-blinded, randomised, controlled
trial that was conducted from December 2022 to May 2023. Patients in the age range of 18-70 who underwent elective coronary artery bypass surgery were included in the
study. In the control group (n=45), the prime solution included Ringer\'s lactate serum. In the intervention group (n=45), the prime solution consisted of 200 mL mannitol serum and Ringer\'s lactate serum. The primary outcome of the
study was the incidence of POD. Secondary outcomes included the duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and 30-day in-hospital mortality.
RESULTS: There were no statistically significant differences in demographic characteristics and risk factors between the control and intervention groups (p<0.05). However, the incidence of POD was significantly lower in the intervention group compared with the control group (22.25% vs 42.2%, p=0.035). There were no significant differences between the two groups regarding CPB time, aortic cross-clamp time, duration of mechanical ventilation and length of stay in ICU (p<0.05). Additionally, mortality rates and rates of return to the operating room did not differ significantly between the two groups (p<0.05).
CONCLUSIONS: This
study concluded that adding mannitol to the prime of CPB pump can help reduce the incidence of delirium after cardiac surgery.
BACKGROUND: IRCT20221129056660N1.