右美托咪定对高心脏风险患者血管手术期间心脏保护的有效性

I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky
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In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. 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引用次数: 0

摘要

目的是研究在血管手术围手术期使用右美托咪定输注治疗的患者围手术期心血管并发症(CVС)的发生率以及临床和实验室心血管保护参数。该研究涉及204名接受择期血管手术的高心脏风险患者(修正心脏风险指数大于2,围术期心肌梗死或心脏骤停风险大于1%)。患者被随机分为两组。I 组患者在围手术期输注右美托咪定,剂量为 0.40 [0.34-0.47] mg/kg/h,时间为 7.0 [6.0-8.0] 小时。第二组为对照组。在围手术期,分析了 CVC 的发生率、血液中 B 型钠尿肽前体 N 端片段(NT-proBNP)和心肌特异性肌钙蛋白 I(cTnI)的水平。采用费雪精确检验、曼-惠特尼检验和逻辑回归对数据进行了统计处理。第一组有 3 名患者(2.9%)和第二组有 14 名患者(13.7%)在围手术期使用 CVC 时未考虑动脉低血压(P = 0.009)。I 组有 14 例(13.7%)患者出现动脉低血压,II 组有 5 例(4.9%)患者出现动脉低血压(P = 0.051)。围术期输注右美托咪定降低了除动脉低血压以外的 CVC 风险(OR 0.1905,95% CI 0.0530-0.6848,p = 0.011),增加了动脉低血压风险(OR 3.5787,95% CI 1.1254-11.3796,p = 0.031)。I 组和 II 组患者术前 cTnI 水平分别为 0.017 [0.011-0.024] 和 0.019 [0.011-0.028] ng/ml(P = 0.196),术后分别为 0.02 [0.011-0.029] 和 0.02[0.015-0.039]纳克/毫升(p = 0.050),出院前分别为 0.018[0.014-0.024]和 0.028[0.018-0.033]纳克/毫升(p = 0.0002)。在同一阶段,NT-proBNP 水平分别为 221.5 [193.3-306.5] 和 237.8 [171.3-310.1] pg/ml(p = 0.572)、237.0 [205-303.5]和 289.0 [217.5-409.5] pg/ml(P = 0.007)、250.5 [198.8-302.0] 和 259.6 [171.0-421.6] pg/ml(P = 0.933)。对于接受血管手术的高心脏风险患者,围手术期输注右美托咪定可降低心脏死亡率、非致死性心肌梗死、心肌缺血、肺栓塞、中风、高血压和心律失常等综合结果的风险,而动脉低血压的风险则会显著增加。cTnI 和 NT-proBNP 的围手术期动态变化需要进一步研究。有 2.7% 的病例在开始输注右美托咪定时伴有严重心动过缓,需要停止输注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effectiveness of dexmedetomidine cardioprotection during vascular surgery in high cardiac risk patients
The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection parameters in patients treated with dexmedetomidine infusion in perioperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received perioperative infusion of dexmedetomidine at a dose 0.40 [0.34–0.47] mg/kg/h during 7.0 [6.0–8.0]) hours. Group II was a control group. In the perioperative period, the occurrence of CVC, the blood level of the N-terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) and cardiospecific troponin I (cTnI) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVC without taking into account arterial hypotension were recorded in 3 (2.9%) patients in group I and in 14 (13.7%) patients in group II (p = 0.009). Arterial hypotension was recorded in 14 (13.7%) patients in group I and in 5 (4.9%) patients in group II (p = 0.051). Perioperative dexmedetomidine infusion reduced the risk of CVC, except for arterial hypotension (OR 0.1905, 95% CI 0.0530–0.6848, p = 0.011) and increased the risk of arterial hypotension (OR 3.5787, 95% CI 1.1254–11.3796, p = 0.031). The cTnI level in patients of groups I and II was 0.017 [0.011–0.024] and 0.019 [0.011–0.028] ng/ml (p = 0.196) before surgery, 0.02 [0.011–0.029] and 0.02 [0.015–0.039] ng/ml (p = 0.050) after surgery, 0.018 [0.014–0.024] and 0.028 [0.018–0.033] ng/ml (p = 0.0002) before discharge from the hospital. At the same stages, the level of NT-proBNP was 221.5 [193.3–306.5] and 237.8 [171.3–310.1] pg/ml (p = 0.572), 237.0 [205–303.5] and 289.0 [217.5–409.5] pg/ml (p = 0.007), 250.5 [198.8–302.0] and 259.6 [171.0–421.6] pg/ml (p = 0.933).Conclusion. In patients at high cardiac risk undergoing vascular surgery, perioperative dexmedetomidine infusion reduces the risk of a composite outcome including cardiac mortality, nonfatal myocardial infarction, myocardial ischemia, pulmonary embolism, stroke, hypertension, and arrhythmias, while the risk of arterial hypotension increases significantly. The perioperative dynamics of cTnI and NT-proBNP require further research. The start of dexmedetomidine infusion in 2.7% of cases is accompanied by severe bradycardia, requiring discontinuation of the infusion.
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