【原】【罂粟摘要】接受心脏手术患者围术期应用右美托咪定与术后5年生存率的关系

罂粟花anesthGH 2021-08-28

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接受心脏手术患者围术期应用右美托咪定与术后5年生存率的关系

翻译：胡廷菊编辑：佟睿审核：曹莹

贵州医科大学高鸿教授课题组

背景

右美托咪定镇静与术后良好的预后有关。我们的目的是评估围术期右美托咪定的使用是否能改善心脏手术后的生存率。

方法

本回顾性队列研究包含2068例接受体外循环下冠状动脉搭桥和/或心脏瓣膜置管术的病人。其中，1029例接受右美托咪定治疗，1039例未使用右美托咪定。在体外循环前或即刻静脉给予右美托托咪定0.007μg/kg/min输注，持续时间小于24h。主要观察指标是术后5年生存率。采用倾向性评分匹配(PSM)、逆概率加权法(IPTW)和重叠加权方法来最小化偏倚。采用Cox比例风险模型进行生存分析。

结　果

两组患者的中位年龄均为63岁，男女比例均为71：29。使用倾向性评分匹配、逆概率加权法及重叠加权进行调整对基线协变量进行平衡。在未经调整的分析中，在心脏手术中接受右美托咪定治疗的患者术后5年的生存率较高。(风险比[HR]=0.63；95%置信区间[CI]，0.51-0.78；P<0.001)，经PSM调整后的(HR=0.63；95%CI，0.45-0.89；P=0.009)，IPTW(HR=0.70；95%CI，0.51-0.95；P=0.023)，或重叠加权调整后(HR=0.67；95%CI，0.51-0.89；P=0.006)。在右美托咪定组和非右美托咪定组心脏手术后5年死亡率分别为12%和20%（PSM校正比值比=0.61；95%置信区间0.42-0.89；P=0.010）。

结　论

接受心脏手术患者围术期输注右美托咪定与术后5年生存率相关。

原始文献来源

Ke Peng, Yue-ping Shen, Yao-yu Ying, et al.

Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery.[J]Br J Anesth.doi: 10.1016/j.bja.2021.03.040

Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery

Abstract

Background: Dexmedetomidine sedation has been associated with favourable outcomes after surgery. We aimed to assess whether perioperative dexmedetomidine use is associated with improved survival after cardiac surgery.

Methods: This retrospective cohort study included 2068 patients undergoing on-pump coronary artery bypass grafting and/or valve surgery. Among them, 1029 patients received dexmedetomidine, and 1039 patients did not. Intravenous

dexmedetomidine infusion of 0.007 μg/kg/min was initiated before or immediately after cardiopulmonary bypass and lasted for < 24 h. The primary outcome was 5-year survival after cardiac surgery. The propensity scores matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting approaches were used to minimise bias. Survival analyses were performed with Cox proportional-hazard models.

Results: The median age was 63 yr old and the male to female ratio was 71:29 in both groups. Baseline covariates were balanced between groups after adjustment using PSM, IPTW, or overlap weighting. Patients receiving dexmedetomidine

in cardiac surgical procedures had higher survival during postoperative 5 yr in unadjusted analysis (hazard ratio [HR]= 0.63; 95% confidence interval [CI], 0.51-0.78; P<0.001), and after adjustment with PSM (HR=0.63; 95% CI, 0.45-0.89; P=0.009), IPTW (HR=0.70; 95% CI, 0.51-0.95; P=0.023), or overlap weighting (HR=0.67; 95% CI, 0.51-0.89; P=0.006). The 5-yr mortality rate after cardiac surgery was 13% and 20% in the dexmedetomidine and non-dexmedetomidine groups, respectively (PSM adjusted odds ratio=0.61; 95% CI, 0.42-0.89; P=0.010).