Clinical study of different sedative methods in critically ill patients after heart surgery / 天津医药

ABSTRACT

Objective To study the effect of light sedation and traditional sedation (moderate sedation with daily sedation interruption) on hemodynamic indexes and prognosis in critically ill patients after cardiac surgery. Methods A total of 134 patients who were ventilated delay after heart surgery in our hospital from January to June 2017 were enrolled in this study. The patients were randomly divided into light sedation group (RASS score-1-1, n=65) and traditional sedation group (RASS score -3--2, n=69). All patients received sufentanil for postoperative analgesia. The light sedation group received propofol and/or dexmedetomidine as sedative drugs after operation, and the conventional sedation group used midazolam for postoperative sedation. The hemodynamic indexes, the first time of weaning off the ventilator, the duration of mechanical ventilation and ICU stay were compared between the two groups. Patients with low cardiac output syndrome after surgery were analyzed in subgroups. Results (1) There were no significant differences in heart function, operative complications and other indicators between the two groups after surgery (all P＞0.05). The low cardiac output syndrome was found in 12 patients in the light sedation group and 10 cases in the traditional sedation group. (2) Hemodynamic monitoring results displayed that the sedation/central venous oxygen saturation (SvO2/ScvO2) and cardiac index (CI) were higher after sedation than before sedation in both groups (all P＜0.05), but there was no significant difference between the two groups (all P＞0.05). Subgroup analysis showed that the SvO2/ScvO2index was higher in patients with low cardiac output syndrome in the traditional sedative group than that in the light sedation group (P＜0.05). There was no difference in the SvO2/ScvO2 index in patients with non-low cardiac output syndrome between two groups. (3) Compared with the traditional sedation group, the first off-line time, the total mechanical ventilation after surgery and the ICU stay time were significantly shortened, and the incidence of postoperative delirium was decreased in the light sedation group (all P＜0.05). Subgroup analysis showed that in patients with non-low cardiac output syndrome, the first off-line time, total postoperative mechanical ventilation time and total ICU stay were significantly shorter in the light sedation group than those in the traditional sedation group (all P＜0.05). There was no significant difference in patients with low cardiac output syndrome between the two groups (P＞0.05). Conclusion Patients with non-low cardiac output syndrome after cardiac surgery benefit significantly from the superficial sedative strategy, and the postoperative mechanical ventilation time and ICU residence time are reduced. The moderate sedation may contribute to the early cardiac function recovery in patients with low cardiac output syndrome.