术中使用右美托咪定改善小儿心脏手术结局：一项为期一年的队列研究。
Intraoperative Dexmedetomidine Improves the Outcome of Pediatric Cardiac Surgery: A One-Year Cohort Study.
作者信息
Xu Fei, Li Lei, Yang Yanli, Liu Wenjun, Ma Jun, Ao Hushan
机构信息
Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, 100011 Beijing, China.
Department of Cardiovascular Surgery, Affiliated Hospital of Weifang Medical University, 261053 Weifang, Shandong, China.
出版信息
Rev Cardiovasc Med. 2023 Oct 12;24(10):289. doi: 10.31083/j.rcm2410289. eCollection 2023 Oct.
BACKGROUND
Pediatric cardiac surgery is associated with a high risk of mortality and morbidity. The aim of this study was to determine if intraoperative dexmedetomidine therapy could improve survival after pediatric cardiac surgery.
METHODS
We conducted a retrospective review of 1384 consecutive children who underwent pediatric cardiac surgery. Amongst these, 889 received dexmedetomidine therapy and 495 did not. All children were followed for 1 year. Their in-hospital and long-term outcomes were compared by multivariate logistic regression to minimize bias, and propensity-score matched adjustment was used.
RESULTS
Children who received dexmedetomidine had lower mortality during the 30-day postoperative period compared to children who did not (1.57% vs. 4.24%; adjusted hazard ratio [HR]: 0.448; 95% confidence interval [CI]: 0.219-0.916, = 0.028), as well as after 1 year (2.36% vs. 6.67%; adjusted [HR]: 0.487; 95% [CI]: 0.274-0.867, = 0.014). The two groups showed no significant differences in cardiovascular complications.
CONCLUSIONS
Dexmedetomidine administered intraoperatively reduced 30-day and 1-year mortality in children undergoing pediatric cardiac surgery.
背景
小儿心脏手术与高死亡率和高发病率相关。本研究的目的是确定术中右美托咪定治疗是否能提高小儿心脏手术后的生存率。
方法
我们对1384例连续接受小儿心脏手术的儿童进行了回顾性研究。其中，889例接受了右美托咪定治疗，495例未接受。所有儿童均随访1年。通过多因素逻辑回归比较他们的住院和长期结局，以尽量减少偏倚，并采用倾向评分匹配调整。
结果
与未接受右美托咪定治疗的儿童相比，接受右美托咪定治疗的儿童术后30天内死亡率较低（1.57%对4.24%；调整后的风险比[HR]：0.448；95%置信区间[CI]：0.219 - 0.916，P = 0.028），1年后也是如此（2.36%对6.67%；调整后的[HR]：0.487；95%[CI]：0.274 - 0.867，P = 0.014）。两组在心血管并发症方面无显著差异。
结论
术中给予右美托咪定可降低小儿心脏手术患儿的30天和1年死亡率。
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