Zientara Alicja, Mariotti Sergio, Matter-Ensner Sonja, Seifert Burkhardt, Graves Kirk, Dzemali Omer, Genoni Michele
Department of Cardiac Surgery, Stadtspital Triemli, Zürich, Switzerland.
Department of Anesthesiology and Intensive Care, Stadtspital Triemli, Zurich, ZH, Switzerland.
Thorac Cardiovasc Surg. 2019 Sep;67(6):450-457. doi: 10.1055/s-0038-1668602. Epub 2018 Aug 28.
Dexmedetomidine (DEX) is a highly selective α-2 agonist with many desirable effects including analgesia, improvement of hemodynamic stability, and potential myocardial and renal protection. The aim of this study was to investigate the effect of DEX on patients undergoing off-pump coronary artery bypass (OPCAB) grafting with regard to less pain medication, earlier extubation, faster transfer to normal ward, and cardiac protection.
From January 2012 to March 2015, 464 patients receiving OPCAB were included for retrospective analysis. After propensity matching (1:1), two groups (DEX vs. propofol, = 129) could be compared. Continuous and categorical variables were reported as mean ± standard deviation or percentages, and compared with the chi-square test and the Mann-Whitney's test, respectively.
In the DEX group, less use of pain medication in the initial phase at intensive care unit was observed. During the first 2 hours, DEX patients received more nicomorphine (DEX 8 ± 3.2 mg vs. propofol 6 ± 4 mg, < 0.001), while in the following 2 hours, the pain medication was significantly reduced (DEX 3.2 ± 2.8 mg vs. propofol 4.7 ± 3.3 mg, < 0.001). Remifentanil was stopped considerably earlier (DEX 238 ± 209 minutes vs. propofol 353 ± 266 minutes, < 0.001). DEX led to earlier extubation (DEX 208 ± 106 minutes vs. propofol 307 ± 230 minutes, < 0.001) and less postoperative atrial fibrillation (AF) ( = 0.01).
Early postoperative DEX application supports the fast-track strategy in patients after OPCAB through enabling rapid extubation, effective pain control, and reduced occurrence of new-onset AF. We are confident to give precedence to DEX over propofol as the new routine medication during postoperative patient transfer.
右美托咪定（DEX）是一种高选择性α-2激动剂，具有多种理想作用，包括镇痛、改善血流动力学稳定性以及潜在的心肌和肾脏保护作用。本研究的目的是探讨右美托咪定对非体外循环冠状动脉搭桥术（OPCAB）患者在减少止痛药使用、更早拔管、更快转至普通病房以及心脏保护方面的效果。
纳入2012年1月至2015年3月接受OPCAB的464例患者进行回顾性分析。经过倾向性匹配（1:1）后，可比较两组（右美托咪定组与丙泊酚组，每组n = 129）。连续变量和分类变量分别以均值±标准差或百分比表示，并分别采用卡方检验和曼-惠特尼检验进行比较。
在右美托咪定组，观察到重症监护病房初始阶段止痛药使用较少。在最初2小时内，右美托咪定组患者接受更多的尼可吗啡（右美托咪定组8 ± 3.2 mg vs. 丙泊酚组6 ± 4 mg，P < 0.001），而在接下来的2小时内，止痛药使用显著减少（右美托咪定组3.2 ± 2.8 mg vs. 丙泊酚组4.7 ± 3.3 mg，P < 0.001）。瑞芬太尼停用时间明显更早（右美托咪定组238 ± 209分钟 vs. 丙泊酚组353 ± 266分钟，P < 0.001）。右美托咪定导致更早拔管（右美托咪定组208 ± 106分钟 vs. 丙泊酚组307 ± 230分钟，P < 0.001）且术后房颤（AF）发生率更低（P = 0.01）。
术后早期应用右美托咪定通过实现快速拔管、有效控制疼痛以及减少新发房颤的发生，支持OPCAB术后患者的快速康复策略。我们有信心在术后患者转运期间将右美托咪定优先于丙泊酚作为新的常规用药。
