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1.河北大学附属医院重症医学科,河北 保定 071030
2.河北医科大学附属第四医院重症医学科,石家庄 050035
主治医师,硕士。研究方向:脓毒症、机械通气。 E-mail:ARDS2023@163.com
主治医师,硕士。研究方向:脓毒症。E-mail:tapse123@163.com
纸质出版日期:2024-02-15,
收稿日期:2023-06-13,
修回日期:2023-11-06,
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吴佳骞,苏丹,邵腾皓等.咪达唑仑与右美托咪定/丙泊酚对机械通气危重症患者镇静治疗有效性和安全性的Meta分析 Δ[J].中国药房,2024,35(03):353-360.
WU Jiaqian,SU Dan,SHAO Tenghao,et al.Meta-analysis of efficacy and safety of sedative therapy with midazolam and dexmedetomidine/propofol in critically ill patients undergoing mechanical ventilation[J].ZHONGGUO YAOFANG,2024,35(03):353-360.
吴佳骞,苏丹,邵腾皓等.咪达唑仑与右美托咪定/丙泊酚对机械通气危重症患者镇静治疗有效性和安全性的Meta分析 Δ[J].中国药房,2024,35(03):353-360. DOI: 10.6039/j.issn.1001-0408.2024.03.16.
WU Jiaqian,SU Dan,SHAO Tenghao,et al.Meta-analysis of efficacy and safety of sedative therapy with midazolam and dexmedetomidine/propofol in critically ill patients undergoing mechanical ventilation[J].ZHONGGUO YAOFANG,2024,35(03):353-360. DOI: 10.6039/j.issn.1001-0408.2024.03.16.
目的
2
系统评价咪达唑仑与右美托咪定/丙泊酚在机械通气危重症患者镇静治疗方面的有效性及安全性,为临床治疗提供循证参考。
方法
2
计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、临床试验资料库(Clinical trials.gov)、中国期刊全文数据库、中文科技期刊数据库、万方数据库、中国生物医学文献数据库,检索时限均为建库起至2023年3月31日,收集咪达唑仑与右美托咪定/丙泊酚在机械通气危重症患者镇静方面的疗效及安全性数据。对符合纳入标准的临床研究进行资料提取后,采用RevMan 5.3统计软件进行Meta分析。
结果
2
共纳入31篇文献,总计2 765例患者。Meta分析结果显示,咪达唑仑组患者机械通气时间[MD=14.13,95%CI(13.75,14.52),
P
<0.000 01]、重症监护病房住院时间[MD=0.92,95%CI(0.54,1.30),
P
<0.000 01]较右美托咪定/丙泊酚组更长;咪达唑仑组患者心动过缓发生率较右美托咪定/丙泊酚组更低[OR=0.60,95%CI(0.41,0.90),
P
=0.01],但两组低血压发生率[OR=0.69,95%CI(0.47,1.01),
P
=0.06]差异无统计学意义;咪达唑仑组患者谵妄[OR=3.88,95%CI(2.74,5.49),
P
<0.000 01]、呼吸机相关性肺炎[OR=2.32,95%CI(1.19,4.51),
P
=0.01]、呼吸抑制[OR=5.70,95%CI(3.09,10.52),
P
<0.000 01]发生率较右美托咪定/丙泊酚组更高。
结论
2
与右美托咪定/丙泊酚类药物比较,咪达唑仑在有效性方面增加了患者的机械通气时间和重症监护病房住院时间,在安全性方面增加了谵妄、肺部并发症的发生风险,但对心血管的影响更小。
OBJECTIVE
2
To systematically evaluate the efficacy and safety of midazolam and dexmedetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation, and to provide evidence-based reference for clinical treatment.
METHODS
2
Retrieved from PubMed, Embase, Web of Science, Cochrane Library, Clinical trials. gov, China Journal Full Text Database, Chinese Science and Technology Journal Database, Wanfang database and China Biomedical Literature Database, the data on the efficacy and safety of midazolam and dexmetomidine/propofol for the sedation of critically ill patients undergoing mechanical ventilation were collected from the establishment of the database to March 31, 2023. After extracting data from clinical studies that met the inclusion criteria, the meta-analysis was conducted by using the RevMan 5.3 statistical software.
RESULTS
2
A total of 31 literature were included, with a total of 2 765 patients. Results of meta-analysis showed that the mechanical ventilation time [MD=14.13, 95%CI (13.75, 14.52),
P
<0.000 01] and the length of hospitalization in the intensive care unit [MD=0.92, 95%CI (0.54, 1.30),
P
<0.000 01] of patients in the midazolam group was longer than dexmedetomidine/propofol group. The incidence of bradycardia in midazolam group was lower dexmedetomidine/propofol group [OR=0.60, 95%CI (0.41, 0.90),
P
=0.01], but there was no statistically significant difference in the incidence of hypotension between the two groups [OR=0.69, 95%CI (0.47, 1.01),
P
=0.06]. The incidence of delirium [OR=3.88, 95%CI (2.74, 5.49),
P
<0.000 01], ventilator-associated pneumonia [OR=2.32, 95%CI (1.19, 4.51),
P
=0.01], and respiratory depression [OR=5.70, 95%CI (3.09, 10.52),
P
<0.000 01] in midazolam group were higher than dexmedetomidine/propofol group.
CONCLUSIONS
2
Compared with dexmedetomidine/propofol, midazolam increases patients’ mechanical ventilation time and the length of hospitalization in the intensive care unit in terms of efficacy, and increases the risk of delirium and pulmonary complications in terms of safety, but has a smaller cardiovascular impact.
咪达唑仑右美托咪定丙泊酚镇静机械通气危重症患者疗效安全性
dexmedetomidinepropofolsedationmechanical ventilationcritically ill patientsefficacysafety
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