Li Fang, Ma Luwei, Yan Suhua, Liu Dongyi
Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
Department of Cardiovascular Medicine, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.
Int J Gen Med. 2025 Jun 27;18:3463-3476. doi: 10.2147/IJGM.S524691. eCollection 2025.
This study aimed to compare the effects of dexmedetomidine (DEX) and propofol on patients undergoing invasive ventilation after off-pump coronary artery bypass grafting (OPCABG) with regard to oxygenation index (OI) (PaO2/FiO2), hemodynamic changes, extubation time, and adverse reactions.
This single-center retrospective study included 195 patients admitted to the cardiovascular surgery intensive care unit (CVICU) after OPCABG between January 2022 and June 2024. According to the postoperative invasive mechanical ventilation for sedation with only DEX or propofol, the patients were classified into groups D and P. The primary outcome was oxygenation index (OI) before and after extubation. The secondary outcomes included mean arterial pressure (MAP) and heart rate (HR) before and after extubation, extubation time, and adverse reactions after surgery.
DEX was significantly associated with an increased likelihood of OI before and after extubation composed to propofol ( < 0.05). MAP and HR after extubation were significantly higher than before extubation in Group P ( < 0.05). However, there were no significant differences between before and after extubation in Group D ( < 0.05). Furthermore, MAP and HR were significantly lower in Group D than in Group P before and after extubation ( < 0.05). In addition, the extubation time was significantly shorter in Group D in comparison of propofol ( < 0.05). Additionally, the incidence of delirium and severe cough at extubation after surgery was significantly lower in Group D than in Group P ( < 0.05).
DEX may support satisfactory OI, good hemodynamic stability, rapid extubation time, and a lower incidence of adverse reactions for sedation of mechanically ventilated patients following OPCABG surgery compared to propofol, although the difference with OI did not reach the MCID.
本研究旨在比较右美托咪定（DEX）和丙泊酚对非体外循环冠状动脉旁路移植术（OPCABG）后接受有创通气患者的氧合指数（OI）（PaO2/FiO2）、血流动力学变化、拔管时间和不良反应的影响。
本单中心回顾性研究纳入了2022年1月至2024年6月在OPCABG术后入住心血管外科重症监护病房（CVICU）的195例患者。根据术后仅使用DEX或丙泊酚进行有创机械通气镇静，将患者分为D组和P组。主要结局是拔管前后的氧合指数（OI）。次要结局包括拔管前后的平均动脉压（MAP）和心率（HR）、拔管时间以及术后不良反应。
与丙泊酚相比，DEX与拔管前后OI升高的可能性显著相关（<0.05）。P组拔管后的MAP和HR显著高于拔管前（<0.05）。然而，D组拔管前后无显著差异（<0.05）。此外，D组拔管前后的MAP和HR显著低于P组（<0.05）。另外，与丙泊酚相比，D组的拔管时间显著更短（<0.05）。此外，D组术后谵妄和拔管时严重咳嗽的发生率显著低于P组（<0.05）。
与丙泊酚相比，DEX可能为OPCABG术后机械通气患者的镇静提供满意的OI、良好的血流动力学稳定性、快速的拔管时间和较低的不良反应发生率，尽管与OI的差异未达到最小临床重要差异（MCID）。
