中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2013年
2期
99-104
,共6页
目的通过荟萃分析(Meta 分析)的方法比较右美托咪定与咪达唑仑、丙泊酚镇静对重症患者预后的影响.方法通过检索美国国立医学图书馆 PubMed 数据库、荷兰医学文摘 Embase 数据库、Cochrane临床试验数据库,并辅以手工检索和文献追溯的方式,收集1990年1月至2012年4月有关比较右美托咪定与咪达唑仑、丙泊酚镇静对重症患者预后影响的随机对照临床试验(RCT)研究,仅限于以英语形式发表的文章,并对收集的 RCT 进行评价,按 Cochrane 协作网推荐的方法对右美托咪定和咪达唑仑、丙泊酚镇静对重症患者的预后进行 Meta 分析,采用 RevMan 5.0软件进行统计学分析.结果最终纳入12个 RCT 研究、共计2117例患者进行分析,其中右美托咪定组患者1108例,咪达唑仑和丙泊酚组患者1009例.与咪达唑仑、丙泊酚比较,右美托咪啶组可显著缩短重症患者的住重症监护病房(ICU)时间〔均数差(MD)为-1.05,95%可信区间(95%CI)为-2.01~-0.39,I 2=100%,P=0.03〕,但并不降低病死率〔相对危险度(RR)为1.04,95%CI 为0.85~1.27,I 2=0%,P=0.72〕和缩短机械通气时间(MD 为-19.33,95%CI 为-47.47~8.80,I 2=100%,P=0.18),也不增加低血压发生率(RR 为1.20,95%CI 为0.95~1.52,I 2=37%,P=0.13)和谵妄的发生率(RR 为0.71,95%CI 为0.46~1.10,I 2=62%,P=0.12),但可增加心动过缓的发生率(RR 为2.03,95%CI 为1.56~2.65,I 2=0%, P<0.00001).采用敏感性分析,去掉低质量的 RCT 研究后显示右美托咪定有降低谵妄发生率的趋势(RR 为0.67,95%CI 为0.45~1.00,I 2=62%,P=0.05).结论与咪达唑仑和丙泊酚比较,右美托咪定可减少重症患者住 ICU 时间和降低谵妄的发生率,但发生心动过缓的风险增高.
目的通過薈萃分析(Meta 分析)的方法比較右美託咪定與咪達唑崙、丙泊酚鎮靜對重癥患者預後的影響.方法通過檢索美國國立醫學圖書館 PubMed 數據庫、荷蘭醫學文摘 Embase 數據庫、Cochrane臨床試驗數據庫,併輔以手工檢索和文獻追溯的方式,收集1990年1月至2012年4月有關比較右美託咪定與咪達唑崙、丙泊酚鎮靜對重癥患者預後影響的隨機對照臨床試驗(RCT)研究,僅限于以英語形式髮錶的文章,併對收集的 RCT 進行評價,按 Cochrane 協作網推薦的方法對右美託咪定和咪達唑崙、丙泊酚鎮靜對重癥患者的預後進行 Meta 分析,採用 RevMan 5.0軟件進行統計學分析.結果最終納入12箇 RCT 研究、共計2117例患者進行分析,其中右美託咪定組患者1108例,咪達唑崙和丙泊酚組患者1009例.與咪達唑崙、丙泊酚比較,右美託咪啶組可顯著縮短重癥患者的住重癥鑑護病房(ICU)時間〔均數差(MD)為-1.05,95%可信區間(95%CI)為-2.01~-0.39,I 2=100%,P=0.03〕,但併不降低病死率〔相對危險度(RR)為1.04,95%CI 為0.85~1.27,I 2=0%,P=0.72〕和縮短機械通氣時間(MD 為-19.33,95%CI 為-47.47~8.80,I 2=100%,P=0.18),也不增加低血壓髮生率(RR 為1.20,95%CI 為0.95~1.52,I 2=37%,P=0.13)和譫妄的髮生率(RR 為0.71,95%CI 為0.46~1.10,I 2=62%,P=0.12),但可增加心動過緩的髮生率(RR 為2.03,95%CI 為1.56~2.65,I 2=0%, P<0.00001).採用敏感性分析,去掉低質量的 RCT 研究後顯示右美託咪定有降低譫妄髮生率的趨勢(RR 為0.67,95%CI 為0.45~1.00,I 2=62%,P=0.05).結論與咪達唑崙和丙泊酚比較,右美託咪定可減少重癥患者住 ICU 時間和降低譫妄的髮生率,但髮生心動過緩的風險增高.
목적통과회췌분석(Meta 분석)적방법비교우미탁미정여미체서륜、병박분진정대중증환자예후적영향.방법통과검색미국국립의학도서관 PubMed 수거고、하란의학문적 Embase 수거고、Cochrane림상시험수거고,병보이수공검색화문헌추소적방식,수집1990년1월지2012년4월유관비교우미탁미정여미체서륜、병박분진정대중증환자예후영향적수궤대조림상시험(RCT)연구,부한우이영어형식발표적문장,병대수집적 RCT 진행평개,안 Cochrane 협작망추천적방법대우미탁미정화미체서륜、병박분진정대중증환자적예후진행 Meta 분석,채용 RevMan 5.0연건진행통계학분석.결과최종납입12개 RCT 연구、공계2117례환자진행분석,기중우미탁미정조환자1108례,미체서륜화병박분조환자1009례.여미체서륜、병박분비교,우미탁미정조가현저축단중증환자적주중증감호병방(ICU)시간〔균수차(MD)위-1.05,95%가신구간(95%CI)위-2.01~-0.39,I 2=100%,P=0.03〕,단병불강저병사솔〔상대위험도(RR)위1.04,95%CI 위0.85~1.27,I 2=0%,P=0.72〕화축단궤계통기시간(MD 위-19.33,95%CI 위-47.47~8.80,I 2=100%,P=0.18),야불증가저혈압발생솔(RR 위1.20,95%CI 위0.95~1.52,I 2=37%,P=0.13)화섬망적발생솔(RR 위0.71,95%CI 위0.46~1.10,I 2=62%,P=0.12),단가증가심동과완적발생솔(RR 위2.03,95%CI 위1.56~2.65,I 2=0%, P<0.00001).채용민감성분석,거도저질량적 RCT 연구후현시우미탁미정유강저섬망발생솔적추세(RR 위0.67,95%CI 위0.45~1.00,I 2=62%,P=0.05).결론여미체서륜화병박분비교,우미탁미정가감소중증환자주 ICU 시간화강저섬망적발생솔,단발생심동과완적풍험증고.
Objective To assess the effects of using dexmedetomidine or midazolam/propofol as sedative agents on the prognosis of intensive care unit(ICU)patients. Methods The literature collected in PubMed, Embase,and the Cochrane Library was retrieved by two researchers independently for randomized controlled trials (RCTs)comparing dexmedetomidine with midazolam/propofol for sedation in critically ill patients. RCTs studied were published in English during the period between January 1990 and April 2012. The quality of the RCTs was evaluated. Meta-analysis of different sedative agents on the prognosis of critically ill was conducted using the methods recommended by the Cochrane Collaboration with RevMan 5.0. Results Among 2117 patients,1108 were included in dexmedetomidine group and 1009 in midazolam/propofol group,as collected from 12 RCTs. A meta-analysis was made. Dexmedetomidine was associated with a significant reduction in length of ICU stay〔mean difference(MD)-1.05, 95% confidence interval(95%CI)-2.01 to -0.39,I 2=100%,P=0.03〕,but without lower mortality rate〔relative risk (RR)1.04,95%CI 0.85 - 1.27,I 2=0%,P=0.72〕or shortened duration of mechanical ventilation(MD -19.33,95%CI-47.47 - 8.80,I 2=100%,P=0.18)when compared with those of midazolam/propofol group. The incidence of hypotension(RR 1.20,95%CI 0.95 - 1.52,I 2=37%,P=0.13)or delirium(RR 0.71,95%CI 0.46 - 1.10,I 2=62%,P=0.12) was also not significantly different between dexmedetomidine and midazolam/propofol. However, dexmedetomidine was associated with increased risk of bradycardia(RR 2.03,95%CI 1.56 - 2.65,I 2=0%,P<0.000 01) when compared with midazolam/propofol. After discarding the low quality RCTs,dexmedetomidine showed a trend of lowering the incidence of delirium(RR 0.67,95%CI 0.45 - 1.00,I 2=62%,P=0.05). Conclusion Dexmedetomidine might reduce the length of ICU stay and incidence of delirium,but the risk of bradycardia was significantly higher when compared with midazolam/propofol.
