Białka Szymon, Copik Maja, Karpe Jacek, Przybyła Maciej, Śliwczyńska Magdalena, Czyżewski Damian, Misiołek Hanna
Department of Anaesthesiology and Intensive Therapy, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice.
Anaesthesiol Intensive Ther. 2018;50(5):359-366. doi: 10.5603/AIT.a2018.0046.
Dexmedetomidine and propofol are commonly used sedative agents in non-invasive ventilation as they allow for easy arousal and are relatively well controllable. Moreover dexmedetomidine is associated with low risk of respiratory depression. However, both agents are associated with significant hemodynamic side effects. The primary objective of this study is to compare the influence of both drugs on hemodynamic effects in patients after thoracic surgical procedures receiving dexmedetomidine or propofol for noninvasive postoperative ventilation.
A prospective, randomised, observational study University Hospital. Interventions: Continuous sedation with dexmedetomidine or propofol for six hours of postoperative non-invasive ventilation after thoracic surgery, with concomitant use of continuous epidural analgesia.
A total of 38 patients (20 dexmedetomidine and 18 propofol) were included in the analysis. The primary outcomes of this study is that heart rate, systolic and mean arterial blood pressure did not differ significantly between the groups, but diastolic arterial blood pressure was significantly higher in propofol group. Comparison analysis of epinephrine usage did not reveal significant differences between the groups. Cardiac output (CO) and cardiac index (CI) analysis did not show significant differences between the groups, but there is a clear tendency of lower values of CO/CI in group receiving propofol. We also observed similar tendency in stroke volume index (SVI) and stroke volume variation (SVV) values, but also those differences did not reach statistical significance. Systemic vascular resistance index (SVRI) values were higher in propofol group, exceeding reference values, but similarly, the difference between the groups was not significant.
The main finding of this study is that dexmedetomidine and propofol provide similar advantages in haemodynamic stability during short-term sedation for non-invasive ventilation after thoracic surgical procedures in patients receiving continuous epidural analgesia.
右美托咪定和丙泊酚是无创通气中常用的镇静剂，因为它们易于唤醒且相对易于控制。此外，右美托咪定与呼吸抑制风险较低有关。然而，这两种药物都与显著的血流动力学副作用有关。本研究的主要目的是比较这两种药物对接受右美托咪定或丙泊酚进行术后无创通气的胸外科手术患者血流动力学的影响。
一项前瞻性、随机、观察性研究，在大学医院进行。干预措施：胸外科手术后进行6小时的无创通气，持续使用右美托咪定或丙泊酚镇静，并同时使用持续硬膜外镇痛。
共有38例患者（20例使用右美托咪定，18例使用丙泊酚）纳入分析。本研究的主要结果是，两组之间的心率、收缩压和平均动脉压无显著差异，但丙泊酚组的舒张压显著更高。肾上腺素使用的比较分析未显示两组之间有显著差异。心输出量（CO）和心脏指数（CI）分析未显示两组之间有显著差异，但接受丙泊酚的组中CO/CI值有明显较低的趋势。我们在每搏量指数（SVI）和每搏量变异（SVV）值中也观察到类似趋势，但这些差异也未达到统计学意义。丙泊酚组的全身血管阻力指数（SVRI）值较高，超过参考值，但同样，两组之间的差异不显著。
本研究的主要发现是，在接受持续硬膜外镇痛的患者进行胸外科手术后短期无创通气镇静期间，右美托咪定和丙泊酚在血流动力学稳定性方面具有相似的优势。
