右美托咪定对接受电视辅助胸腔镜手术患者术后高敏心肌肌钙蛋白 T 的影响：一项前瞻性、随机对照试验。

Effect of dexmedetomidine on postoperative high-sensitivity cardiac troponin T in patients undergoing video-assisted thoracoscopic surgery: a prospective, randomised controlled trial.

机构信息

Department of Anesthesiology and Pain Medicine, Affiliated Hospital of Jiaxing University, No.1882, South Central Road, Jiaxing City, Zhejiang Province, China.

出版信息

BMC Pulm Med. 2024 Oct 10;24(1):500. doi: 10.1186/s12890-024-03325-x.

DOI:10.1186/s12890-024-03325-x

PMID:39390494

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11465541/

Abstract

BACKGROUND

One-lung ventilation and intrathoracic operations during thoracoscopic surgery often result in intraoperative hypoxaemia and haemodynamic fluctuations, resulting in perioperative myocardial injury. Dexmedetomidine, an alpha-2 (α-2) agonist, has demonstrated myocardial protection. We hypothesize that the routine intravenous administration of dexmedetomidine could reduce the extent of myocardial injury during video-assisted thoracoscopic surgery (VATS).

METHODS

The study included patients aged ≥ 45 years, classified as American Society of Anesthesiologists physical status I-III, who underwent general anesthesia for video-assisted thoracoscopic surgery. The patients were randomly assigned to either the intervention group, receiving general anesthesia with dexmedetomidine, or the control group, receiving general anesthesia without dexmedetomidine. Patients in the intervention group received a loading dose of dexmedetomidine (0.5 µg·kg) before anesthesia induction, followed by a continuous infusion (0.5 µg·kg·h) until the completion of the surgery. Placebos (saline) were administered for the control group to match the treatment. The primary outcome assessed was the high-sensitivity cardiac troponin T on postoperative day 1. Additionally, the incidence of myocardial injury after noncardiac surgery (MINS) was noted.

RESULTS

A total of 110 participants completed this study. The median [interquartile range (IQR)] concentration of hs-cTnT on postoperative day 1 was lower in the intervention group compared with the control group (7 [6-9] vs. 8 [7-11] pg·ml; difference in medians,1 pg·ml; 95% confidence interval [CI], 0 to 2; P = 0.005). Similarly, on postoperative day 3, the median [IQR] concentration of hs-cTnT in the intervention group was also lower than that in the control group (6 [5-7] vs. 7 [6-9]; difference in medians,1 pg·ml; 95%CI, 0 to 2; P = 0.011). Although the incidence of MINS was not statistically significant (the intervention group vs. the control group, 3.8% vs. 9.1%, P = 0.465), there was a decreasing trend in the incidence of MINS in the intervention group.

CONCLUSION

The administration of perioperative dexmedetomidine in patients ≥ 45 years undergoing video-assisted thoracoscopic surgery could lower the release of postoperative hs-cTnT without reducing incidence of myocardial injury.

TRIAL REGISTRATION

chictr.org.cn (ChiCTR2200063193); prospectively registered 1 September 2022.

摘要

背景

胸腔镜手术中的单肺通气和胸腔内操作常导致术中低氧血症和血流动力学波动，从而导致围手术期心肌损伤。右美托咪定是一种α-2（α-2）激动剂，具有心肌保护作用。我们假设常规静脉给予右美托咪定可减少电视辅助胸腔镜手术（VATS）期间的心肌损伤程度。

方法

本研究纳入了年龄≥45 岁、美国麻醉医师协会身体状况 I-III 级的患者，他们接受全身麻醉行 VATS。患者被随机分配到干预组（接受右美托咪定全身麻醉）或对照组（接受无右美托咪定的全身麻醉）。干预组患者在麻醉诱导前接受右美托咪定负荷剂量（0.5μg·kg），然后以 0.5μg·kg·h 的速度持续输注，直到手术结束。对照组给予安慰剂（生理盐水）以匹配治疗。主要结局评估为术后第 1 天高敏肌钙蛋白 T。此外，还记录了非心脏手术后心肌损伤（MINS）的发生率。

结果

共有 110 名参与者完成了这项研究。与对照组相比，干预组术后第 1 天的 hs-cTnT 中位数[四分位距（IQR）]浓度较低（7[6-9]与 8[7-11]pg·ml；中位数差异，1pg·ml；95%置信区间[CI]，0 至 2；P=0.005）。同样，在术后第 3 天，干预组的 hs-cTnT 中位数[IQR]浓度也低于对照组（6[5-7]与 7[6-9]；中位数差异，1pg·ml；95%CI，0 至 2；P=0.011）。尽管 MINS 的发生率没有统计学意义（干预组 vs. 对照组，3.8% vs. 9.1%，P=0.465），但干预组 MINS 的发生率呈下降趋势。