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| 精准麻醉对心血管手术患者术后谵妄的影响 |
| Effects of precision anesthesia on postoperative delirium in patients undergoing cardiovascular surgery |
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| DOI：10.12089/jca.2020.11.009 |
| 中文关键词: 精准麻醉 术后谵妄 心血管手术 靶控输注 |
| 英文关键词: Precision anesthesia Postoperative delirium Cardiovascular surgery Target-controlled infusion |
| 基金项目:北京市自然科学基金京津冀基础研究合作专项（19JCZDJC65100） |
| 作者 | 单位 | E-mail | | 高宇晨 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | | | 王越夫 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | | | 王剑辉 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | stewenwang@sina.com | | 杜娟 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院,成人术后恢复室 | | | 李军 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | | | 石晟 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | | | 王春蓉 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | | | 王苏德娜 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | | | 田宇 | 100037,中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院麻醉中心 | |
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| 中文摘要: |
目的 通过比较精准麻醉和传统麻醉在心血管手术中的应用，探讨精准麻醉对患者术后谵妄的影响。
方法 选择在我院行择期心血管手术患者249例，男167例，女82例，年龄25~84岁，BMI 17~37 kg/m2，ASA Ⅱ—Ⅳ级，心功能分级(NYHA)Ⅰ—Ⅳ级。将患者随机分为两组：精准麻醉组（P组）和传统麻醉组（T组），每组125例。P组进行精准的麻醉实施、用药和麻醉管理，T组则采用传统的经验式麻醉管理。记录手术时间、心肺转流（CPB）时间、阻断时间、术中舒芬太尼用量及手术类型。使用ICU意识模糊评估法（CAM-ICU）来评估术后5 d内谵妄发生情况，记录谵妄发生与持续时间。记录术后机械通气时间，ICU住院时间，术后住院时间和总住院费用。
结果 术后5 d内发生谵妄为30例（12.0%），其中P组为9例（7.2%），T组为21例（16.9%）。与T组比较，P组术后5 d内谵妄发生率明显降低（P＜0.05），住院费用明显降低(P＜0.01)，术后机械通气时间、ICU住院时间、术后住院时间明显缩短（P＜0.01）。P组术后二次插管、二次ICU、术后气胸的发生率均低于T组，但两组间差异无统计学意义。
结论 精准麻醉可以有效降低心血管手术后5 d内的谵妄发生率，同时能减少患者术后机械通气时间和ICU住院时间。 |
| 英文摘要: |
Ojective To compared the effect of precision anesthesia and traditional anesthesia in cardiovascular surgery, and to explore the effect of precision anesthesia on the prevalence of postoperative delirium.
Methods A total of 249 patients scheduled for cardiovascular surgery, 167 males and 82 females, aged 25-84 years, BMI 17-37 kg/m2, ASA physical status Ⅱ-Ⅳ, NYHA grades Ⅰ-Ⅳ, were enrolled in this study. They were randomly divided into two groups: a precision anesthesia group (group P, n = 125) and a traditional anesthesia group (group T, n = 125). Patients in group P were receiving accurate anesthesia implementation, medication and management, whereas patients in group T were treated with traditional anesthetic management based on clinical experience. The following information of patients was recorded: operation time, cardiopulmonary bypass (CPB) time, aortic cross-clamping time, intraoperative sufentanil dosage and operation type. Delirium was assessed with the CAM-ICU during the first 5 postoperative days. The occurrence and duration of delirium were recorded. Ventilation time, ICU length of stay, postoperative hospital length of stay and hospitalization expenses were also recorded.
Results The total incidence of delirium within 5 d after operation was 30 cases (12.0%), which 9 cases (7.2%) in group P, and 21 cases (16.9%) in group T. Compared with group T, the incidence of delirium within 5 d after the operation in group P was significantly reduced (P < 0.05), patients in group P had lower hospital costs and shorter duration of ventilation, ICU and postoperative hospital stay (P < 0.01). The incidence of re-intubation, re-ICU and pneumothorax in group P were lower than group T, however, there was no significant difference between the two groups.
Conclusion Precision anesthesia can effectively reduce the incidence of delirium within 5 d after cardiac surgery. Meanwhile it can reduce the time of mechanical ventilation and ICU hospitalization. |
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