可乐定和右美托咪定在心脏手术后重症患者中的心血管安全性。
Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery.
作者信息
Grest Angelina, Kurmann Judith, Müller Markus, Jeger Victor, Krüger Bernard, Spahn Donat R, Bettex Dominique, Rudiger Alain
机构信息
Institute for Anaesthesiology, University Zurich and University Hospital Zurich, Zürich, Switzerland.
出版信息
Crit Care Res Pract. 2020 May 7;2020:4750615. doi: 10.1155/2020/4750615. eCollection 2020.
PURPOSE
The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery.
METHODS
2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages).
RESULTS
Patients receiving clonidine ( = 193) were younger (66 (57-73) vs 70 (63-77) years, =0.003) and had a lower SAPS II (35 (27-48) vs 41 (31-54), =0.008) compared with patients receiving dexmedetomidine ( = 141). At the start of the drug infusion, HR (90 (75-100) vs 90 (80-105) bpm, =0.028), MAP (70 (65-80) vs 70 (65-75) mmHg, =0.093), and norepinephrine (0.05 (0.00-0.11) vs 0.12 (0.03-0.19) mcg/kg/min, < 0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (-0.04-0.02) mcg/kg/min) and decreased in the dexmedetomidine group (-0.03 (-0.10-0.02) mcg/kg/min, =0.007).
CONCLUSIONS
Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.
目的
本回顾性研究旨在评估可乐定和右美托咪定对心脏手术后重症患者的血流动力学不良影响。
方法
在30个月的研究期间筛选了2769例患者。在持续药物输注的前12小时内，每3小时评估一次心率（HR）、平均动脉压（MAP）和去甲肾上腺素需求量。结果以中位数（四分位间距）或数字（百分比）表示。
结果
与接受右美托咪定的患者（n = 141）相比，接受可乐定的患者（n = 193）更年轻（66（57 - 73）岁 vs 70（63 - 77）岁，P = 0.003）且急性生理与慢性健康状况评分系统II（SAPS II）更低（35（27 - 48）vs 41（31 - 54），P = 0.008）。在开始药物输注时，记录到接受可乐定和右美托咪定患者的HR（90（75 - 100）vs 90（80 - 105）次/分钟，P = 0.028）、MAP（70（65 - 80）vs 70（65 - 75）mmHg，P = 0.093）和去甲肾上腺素（0.05（0.00 - 0.11）vs 0.12（0.03 - 0.19）μg/kg/分钟，P < 0.001）。可乐定组有7.8%发生心动过缓（HR < 60次/分钟），右美托咪定组为5.7%（P = 0.51）。在基线至12小时期间，可乐定组去甲肾上腺素保持稳定（0.00（ - 0.04 - 0.02）μg/kg/分钟），右美托咪定组则下降（ - 0.03（ - 0.10 - 0.02）μg/kg/分钟，P = 0.007）。
结论
右美托咪定和低成本药物可乐定均可安全用于心脏手术后的特定患者。
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