背景:我们试图探讨右美托咪定作为心脏手术的麻醉辅助药物与心脏重症监护病房(CICU)术后并发症和住院时间(LOS)之间的关系。
方法:我们对2020年10月至2022年6月期间接受心脏瓣膜手术的18岁及以上患者进行了回顾性研究。研究的主要终点是主要的术后并发症(心脏骤停,心房颤动,心肌损伤/梗塞,心力衰竭),次要终点是CICULOS延长(定义为LOS>第90百分位数)。对在单因素分析中有显著性的变量进行多因素logistic回归分析。
结果:共有856名患者进入我们的研究。283名经历了主要和次要终点的患者被纳入不良结局组,其余573例纳入预后对照组.多因素Logistic回归分析显示年龄>60岁(比值比[OR],1.68;95%置信区间[CI],1.23-2.31;p<0.01),体外循环(CPB)>180分钟(OR,1.62;95%CI,1.03-2.55;p=0.04),术后机械通气时间>10h(OR,1.84;95%CI,1.35~2.52;p<0.01)是术后主要并发症的独立危险因素;年龄>60岁(OR,3.20;95%CI,1.65-6.20;p<0.01),术前NYHA第4类(或,4.03;95%CI,1.74-9.33;p<0.01),糖尿病(OR,2.57;95%CI,1.22-5.41;p=0.01),术中红细胞(RBC)输血>650ml(OR,2.04;95%CI,1.13-3.66;p=0.02),术中出血>1200ml(OR,2.69;95%CI,1.42-5.12;p<0.01)是CU住院时间延长的独立危险因素。术中使用右美托咪定作为麻醉辅助药物是主要并发症的保护因素(比值比,0.51;95%置信区间,0.35-0.74;p<0.01)和延长CICU停留时间。(赔率比,0.37;95%置信区间,0.19-0.73;p<0.01)。
结论:在接受心脏瓣膜手术的患者中,年龄,体外循环的持续时间,机械通气的持续时间与主要的术后并发症有关。年龄,术前NYHA分类4,糖尿病,术中出血,红细胞输血与CICU住院时间增加相关。术中使用右美托咪定可改善此类临床结果。
We sought to explore the relationship between dexmedetomidine as an anesthetic adjuvant in cardiac surgery and postoperative complications and length of stay (LOS) in the cardiac intensive care unit (CICU).
We conducted a retrospective study of patients aged 18 years and older who underwent heart valve surgery between October 2020 and June 2022. The primary endpoint of the study was major postoperative complications (cardiac arrest, atrial fibrillation, myocardial injury/infarction, heart failure) and the secondary endpoint was prolonged CICU LOS (defined as LOS > 90th percentile). Multivariate logistic regression analysis was performed for variables that were significant in the univariate analysis.
A total of 856 patients entered our study. The 283 patients who experienced the primary and secondary endpoints were included in the adverse outcomes group, and the remaining 573 were included in the prognostic control group. Multivariate logistic regression analysis revealed that age > 60 years (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.23-2.31; p < 0.01), cardiopulmonary bypass (CPB) > 180 min (OR, 1.62; 95% CI, 1.03-2.55; p = 0.04) and postoperative mechanical ventilation time > 10 h (OR, 1.84; 95% CI, 1.35-2.52; p < 0.01) were independent risk factors for major postoperative complications; Age > 60 years (OR, 3.20; 95% CI, 1.65-6.20; p < 0.01), preoperative NYHA class 4 (OR, 4.03; 95% CI, 1.74-9.33; p < 0.01), diabetes mellitus (OR, 2.57; 95% CI, 1.22-5.41; p = 0.01), Intraoperative red blood cell (RBC) transfusion > 650 ml (OR, 2.04; 95% CI, 1.13-3.66; p = 0.02), Intraoperative bleeding > 1200 ml (OR, 2.69; 95% CI, 1.42-5.12; p < 0.01) were independent risk factors for prolonged CICU length of stay. Intraoperative use of dexmedetomidine as an anesthetic adjunct was a protective factor for major complications (odds ratio, 0.51; 95% confidence interval, 0.35-0.74; p < 0.01) and prolonged CICU stay. (odds ratio, 0.37; 95% confidence interval, 0.19-0.73; p < 0.01).
In patients undergoing heart valve surgery, age, duration of cardiopulmonary bypass, and duration of mechanical ventilation are associated with major postoperative complication. Age, preoperative NYHA classification 4, diabetes mellitus, intraoperative bleeding, and RBC transfusion are associated with increased CICU length of stay. Intraoperative use of dexmedetomidine may improve such clinical outcomes.