Combined Use of Dexmedetomidine and Hydrocortisone to Prevent New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery: A Randomized Clinical Trial.

IF 1.1 Q3 ANESTHESIOLOGY
Mohamed Alaaeldin Alhadidy, Adel Mohamed Alansary, Sarah Hamdy Elghareeb
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引用次数: 0

Abstract

Objective: Postoperative atrial fibrillation (POAF) occurs in 20%-40% of patients following coronary artery bypass grafting (CABG), contributing to significant morbidity. POAF is linked to elevated catecholamines, oxidative stress, and inflammatory mediators. Dexmedetomidine, a centrally acting alpha-2 agonist with sympatholytic and anti-inflammatory effects, and hydrocortisone, which suppresses inflammatory mediators, may reduce the incidence of POAF. Methods: A prospective, double-blind randomized controlled trial was conducted on 248 patients undergoing elective on-pump CABG at Ain Shams University Hospital. Patients were randomized into 2 groups: the Treatment Group received dexmedetomidine and hydrocortisone, and the Placebo Group received standard care. The primary endpoint was the occurrence of POAF within 7 days postoperatively. Results: All 248 patients (124 per group) completed the study. The combined use of dexmedetomidine and hydrocortisone reduced POAF incidence (4.8% vs 12.9%). ICU and hospital length of stay were also shorter in the Treatment Group (2.77 ± 1.12 vs 3.16 ± 1.34 days, P = .012, and 6.63 ± 1.56 vs 7.11 ± 2 days, P = .035, respectively). No differences in hypotension, bradycardia, or wound infections were observed. Hyperglycemia, defined as blood glucose >180 mg/dl, occurred in 8.1% of the Treatment Group and 6.5% of the Placebo Group. Conclusion: Combining dexmedetomidine and hydrocortisone effectively reduces POAF incidence after CABG, with manageable side effects. Multicenter trials are warranted to confirm these findings. Date and Number of IRB Approval and Clinical Trial Registry Number. Ain Shams University Protocol Record (FMASU R 261/2022), ClinicalTrials.gov Identifier: NCT05674253.

联合使用右美托咪定和氢化可的松预防冠状动脉搭桥术后新发心房颤动:一项随机临床试验。
目的:冠状动脉旁路移植术(CABG)术后心房颤动(POAF)发生率为20%-40%,发病率较高。POAF与儿茶酚胺、氧化应激和炎症介质升高有关。右美托咪定(一种具有交感神经溶解和抗炎作用的中枢作用α -2激动剂)和氢化可的松(一种抑制炎症介质的药物)可能降低POAF的发生率。方法:对248例在艾因沙姆斯大学医院择期行非泵式冠脉搭桥的患者进行前瞻性、双盲随机对照试验。患者随机分为两组:治疗组给予右美托咪定和氢化可的松治疗,安慰剂组给予标准治疗。主要终点为术后7天内POAF的发生情况。结果:248例患者(每组124例)全部完成研究。右美托咪定和氢化可的松联合使用可降低POAF发生率(4.8% vs 12.9%)。治疗组的ICU和住院时间也较短(分别为2.77±1.12天和3.16±1.34天,P = 0.012; 6.63±1.56天和7.11±2天,P = 0.035)。在低血压、心动过缓或伤口感染方面没有观察到差异。高血糖,定义为血糖低于180 mg/dl,治疗组的高血糖发生率为8.1%,安慰剂组为6.5%。结论:右美托咪定联合氢化可的松可有效降低冠脉搭桥术后POAF的发生率,且副作用可控。需要多中心试验来证实这些发现。IRB批准日期和编号以及临床试验注册编号。艾因沙姆斯大学协议记录(FMASU R 261/2022), ClinicalTrials.gov标识符:NCT05674253。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.60
自引率
14.30%
发文量
31
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