右美托咪定对儿茶酚胺和炎症的影响减少老年STEMI患者行初次PCI的住院不良事件

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-10-02 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S542160

Guang-An Liu, Wanglong Wu, Linxiao Zhou, Ruoxi Zhang, Feng Liu

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引用次数: 0

摘要

目的：本研究旨在评估右美托咪定（DEX）对接受初级经皮冠状动脉介入治疗（PCI）的st段抬高型心肌梗死（STEMI）老年患者焦虑和炎症的影响，以及其减少住院不良事件的潜力。方法：我们进行了一项回顾性的现实世界队列研究，纳入了160名在2020年9月至2024年12月期间入住心脏护理病房（CCU）的老年STEMI患者。患者分为两组：DEX和non-DEX。根据人口学和临床变量采用倾向评分匹配（PSM， 1:1比例），确保比较的平衡组。我们在四个时间点（T0-T3）评估儿茶酚胺和炎症水平，使用阿姆斯特丹术前焦虑和信息量表（APAIS）评估焦虑，以及认知功能。DEX组的累积MACE发生率（20.00% vs 38.8%, P = 0.015）和VT/VF发生率（1.3% vs 10.0%, P = 0.034）显著低于非DEX组。采用多变量logistic回归来确定院内主要心脏不良事件（MACE）的危险因素。结果：与非DEX组相比，DEX组pci后儿茶酚胺（去甲肾上腺素，P < 0.001；肾上腺素，P = 0.001；多巴胺，P < 0.001）和炎症水平（hs-CRP, P < 0.001）明显降低。此外，DEX组各时间点心率（HR）（T1, P < 0.001; T2, P < 0.001; T3, P = 0.007）和呼吸速率（RR）（T1, P < 0.001; T2, P < 0.001）均降低，血氧饱和度（SpO2）（T1, P = 0.045; T2, P < 0.001; T3, P < 0.001; T4, P = 0.016）均升高。DEX组患者T1 （P = 0.007）、T2 （P < 0.001）时Ramsay镇静评分高于T0时，T1 （P = 0.021）、T1 （P = 0.017）至T3 （P = 0.015）时焦虑评分较前一个时间点显著降低。DEX是院内MACE降低的独立预测因子[优势比(OR) = 0.244, 95%可信区间(CI) = 0.082 ~ 0.728, P = 0.011]。结论：DEX与较低的儿茶酚胺和炎症水平相关，可提供足够的镇静作用，对于接受初级PCI治疗的老年STEMI患者具有安全性、可行性和有效性。

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Dexmedetomidine's Effect on Catecholamine and Inflammation in Reducing In-Hospital Adverse Events for Older Patients with STEMI Undergoing Primary PCI.

Objective: This study aimed to assess the effects of dexmedetomidine (DEX) on anxiety and inflammation, and its potential in reducing in-hospital adverse events in older patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods: We conducted a retrospective, real-world cohort study, enrolling 160 elderly patients with STEMI admitted to the cardiac care unit (CCU) between September 2020 and December 2024. Patients were divided into two groups: DEX and non-DEX. Propensity score matching (PSM, 1:1 ratio) was applied based on demographic and clinical variables, ensuring balanced groups for comparison. We evaluated catecholamine and inflammation levels, anxiety using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and cognitive function at four time points (T0-T3). The incidence of cumulative MACE (20.00% vs 38.8%, P = 0.015) and VT/VF (1.3% vs 10.0%, P = 0.034) was significantly lower in the DEX group compared to the non-DEX group. Multivariable logistic regression was performed to identify risk factors for in-hospital major adverse cardiac events (MACE).

Results: The DEX group had significantly lower catecholamine (norepinephrine, P < 0.001; epinephrine, P = 0.001; dopamine, P < 0.001) and inflammation levels (hs-CRP, P < 0.001) post-PCI compared to the non-DEX group. Additionally, heart rate (HR) (T1, P < 0.001; T2, P < 0.001; T3, P = 0.007) and respiratory rate (RR) (T1, P < 0.001; T2, P < 0.001) were lower, while blood oxygen saturation (SpO₂) (T1, P = 0.045; T2, P < 0.001; T3, P < 0.001; T4, P = 0.016) was higher in the DEX group at various time points. In the DEX group, Ramsay Sedation Scores were higher at T1 (P = 0.007) and T2 (P < 0.001) than at T0, and anxiety scores decreased significantly from T1 (P = 0.021), T1 (P = 0.017) to T3 (P = 0.015) compared with the preceding time point. DEX was identified as an independent predictor of reduced in-hospital MACE [odds ratio (OR) = 0.244, 95% confidence interval (CI) = 0.082-0.728, P = 0.011].

Conclusion: DEX was associated with lower catecholamine and inflammation levels, provided adequate sedation, and appeared safety, feasibility, and effectiveness for older patients with STEMI undergoing primary PCI.

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.