盐酸戊乙奎醚联合右美托咪定对心脏瓣膜手术患者肺功能的影响：一项双盲、随机试验。
Effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery: a double-blind, randomized trial.
机构信息
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
出版信息
BMC Anesthesiol. 2023 Jul 13;23(1):237. doi: 10.1186/s12871-023-02176-z.
AIM
To investigate the effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery with cardiopulmonary bypass (CPB).
METHODS
A total of 180 patients undergoing elective heart valve surgery with CPB were randomly divided into four groups: 45 in group P (intravenous penehyclidine hydrochloride 0.02 mg/kg 10 min before anesthesia induction and at the beginning of CPB, total 0.04 mg/kg); 43 in group D (dexmedetomidine 0.5 μg/kg/h after induction of anesthesia until the end of anesthesia); 44 in group PD ( penehyclidine hydrochloride 0.04 mg/kg combined with dexmedetomidine 0.5 μg/kg/h intravenously during anesthesia); and 43 in group C (same amount of normal saline 10 min before and after anesthesia induction, to the end of anesthesia, and at the beginning of CPB). The main outcomes were the incidence and severity of postoperative pulmonary complications (PPCs). The secondary outcomes were: (1) extubation time, length of stay in intensive care, and postoperative hospital stay, and adverse events; and (2) pulmonary function evaluation indices (oxygenation index and respiratory index) and plasma inflammatory factor concentrations (tumor necrosis factor-α, interleukin-6, C-reactive protein and procalcitonin) during the perioperative period.
RESULTS
The incidence of PPCs in groups P, D and PD after CPB was lower than that in group C (P < 0.05), and the incidence in group PD was significantly lower than that in groups P and D (P < 0.05). The scores for PPCs in groups P, D and PD were lower than those in group C (P < 0.05).
CONCLUSION
Combined use of penehyclidine hydrochloride and dexmedetomidine during anesthesia reduced the occurrence of postoperative pulmonary dysfunction, and improved the prognosis of patients undergoing heart valve surgery with CPB.
TRIAL REGISTRATION
The trial was registered in the Chinese Clinical Trial Registry on 3/11/2020 (Registration No.: ChiCTR2000039610).
目的
观察盐酸戊乙奎醚复合右美托咪定对体外循环（CPB）下心瓣膜置换术患者肺功能的影响。
方法
选择择期行 CPB 下心瓣膜置换术患者 180 例，随机分为 4 组：麻醉诱导前 10 min 和 CPB 开始时静脉注射盐酸戊乙奎醚 0.02 mg/kg，总量 0.04 mg/kg（P 组）；麻醉诱导后静脉泵注右美托咪定 0.5 μg/kg/h（D 组）；麻醉期间静脉泵注盐酸戊乙奎醚 0.04 mg/kg 复合右美托咪定 0.5 μg/kg/h（PD 组）；麻醉诱导前后 10 min 及麻醉结束至 CPB 开始时静脉给予等容量生理盐水（C 组）。观察术后肺部并发症（PPCs）的发生情况及严重程度。记录拔管时间、重症监护病房（ICU）停留时间、术后住院时间及不良反应发生情况。检测并比较各组患者围术期肺功能评估指标（氧合指数和呼吸指数）、血浆炎性因子浓度[肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C 反应蛋白（CRP）和降钙素原（PCT）]。
结果
CPB 后 P、D 和 PD 组 PPCs 的发生率均低于 C 组（P<0.05），PD 组低于 P 组和 D 组（P<0.05）。P、D 和 PD 组 PPCs 评分均低于 C 组（P<0.05）。
结论
麻醉期间复合应用盐酸戊乙奎醚和右美托咪定可降低体外循环下心瓣膜置换术患者术后肺功能障碍的发生，改善患者的预后。
试验注册
本研究于 2020 年 3 月 11 日在中国临床试验注册中心注册（注册号：ChiCTR2000039610）。
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