Hong Hong, Xue Li, Jing Yang, Yan Zhang, Guang-Yu Liu, Fu-Xia Yan, Dong-Xin Wang
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Secondary outcomes included major adverse cardiovascular events (MACE)-free and hospital-free survivals, as well as cognitive function and quality of life in 6-year survivors.</p><p><strong>Results: </strong>All 285 patients were included in final analysis. Median follow-up duration was 80 months (interquartile range 30 to 80). Overall survival did not differ between the two groups: there were 18 deaths (12.6%) with placebo versus 22 deaths (15.5%) with dexmedetomidine; hazard ratio (HR) 1.22, 95% CI 0.65 to 2.27, p = 0.418. MACE-free survival was 23 (16.1%) with placebo versus 24 (16.9%) with dexmedetomidine; HR 1.03, 95% CI 0.58 to 1.83, P = 0.911. Hospital-free survival was 39 (27.3%) with placebo versus 42 (29.6%) with dexmedetomidine; HR 1.04, 95% CI 0.67 to 1.61, P = 0.853. 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引用次数: 0
摘要
背景：据报道，右美托咪定可以减少心脏手术后的并发症甚至住院死亡率。因此，我们验证了围手术期右美托咪定可能改善心脏手术后长期预后的假设。方法：这是一项长期随访的随机试验。我们招募了285名60岁或以上的患者，他们计划进行择期心脏手术。患者在手术期间和术后早期随机接受右美托咪定或安慰剂（生理盐水）。术后随访6年。主要终点是总生存期。次要结局包括无主要不良心血管事件（MACE）和无医院生存，以及6年存活者的认知功能和生活质量。结果：285例患者均纳入最终分析。中位随访时间为80个月（四分位数范围30 ~ 80）。两组的总生存率没有差异：安慰剂组有18例死亡（12.6%），右美托咪定组有22例死亡（15.5%）；风险比（HR） 1.22, 95% CI 0.65 ~ 2.27, p = 0.418。安慰剂组无mace生存期为23例（16.1%），右美托咪定组为24例（16.9%）；HR 1.03, 95% CI 0.58 ~ 1.83, P = 0.911。安慰剂组的无院生存期为39例（27.3%），右美托咪定组为42例（29.6%）；HR 1.04, 95% CI 0.67 ~ 1.61, P = 0.853。在6年存活者中，两组之间的认知功能和生活质量评分相似。结论：我们发现，对于接受择期心脏手术的老年患者，手术期间和术后早期给予右美托咪定不会改变总体生存率和无mace生存率，以及长期认知功能和生活质量。然而，考虑到样本量不足和随访率不可忽略的损失，我们的结果需要进一步确认。试验注册：ClinicalTrials.gov: NCT03289325（2017年9月20日）。
Impact of perioperative dexmedetomidine on long-term outcomes in older patients following cardiac surgery: follow-up of a randomized trial.
Background: Perioperative dexmedetomidine is reported to reduce complications and even in-hospital mortality after cardiac surgery. We therefore tested the hypothesis that perioperative dexmedetomidine may improve long-term outcomes after cardiac surgery.
Methods: This was long-term follow-up of a randomized trial. We enrolled 285 patients aged 60 years or older who were scheduled for elective cardiac surgery. Patients were randomized to receive either dexmedetomidine or placebo (normal saline) during and early after surgery. Follow-up was conducted for up to 6 years post-surgery. The primary endpoint was overall survival. Secondary outcomes included major adverse cardiovascular events (MACE)-free and hospital-free survivals, as well as cognitive function and quality of life in 6-year survivors.
Results: All 285 patients were included in final analysis. Median follow-up duration was 80 months (interquartile range 30 to 80). Overall survival did not differ between the two groups: there were 18 deaths (12.6%) with placebo versus 22 deaths (15.5%) with dexmedetomidine; hazard ratio (HR) 1.22, 95% CI 0.65 to 2.27, p = 0.418. MACE-free survival was 23 (16.1%) with placebo versus 24 (16.9%) with dexmedetomidine; HR 1.03, 95% CI 0.58 to 1.83, P = 0.911. Hospital-free survival was 39 (27.3%) with placebo versus 42 (29.6%) with dexmedetomidine; HR 1.04, 95% CI 0.67 to 1.61, P = 0.853. Among 6-year survivors, the scores of cognitive function and quality of life were similar between groups.
Conclusions: We found that, for older patients undergoing elective cardiac surgery, dexmedetomidine administered during and early after surgery did not alter overall and MACE-free survivals, as well as long-term cognitive function and quality of life. However, considering the underpowered sample size and non-negligible loss to follow-up rate, our results need further confirmation.
期刊介绍：
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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