重症监护室重症病人采用右美托咪定和咪达唑仑镇静治疗的有效性和安全性的Meta分析  

A meta-analysis of the effect and safety of dexmedetomidine and midazolam for sedation in critically ill patients in intensive care units

作　　者：唐志红[1] 李娜[1] 许静[1] 田永明[1] TANG Zhihong;LI Na;XU Jing;TIAN Yongming(Intensive Care Unit,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院重症医学科

出　　处：《安徽医药》2020年第3期534-540,共7页Anhui Medical and Pharmaceutical Journal

基　　金：四川省卫计委科研课题(18PJ237)

摘　　要：目的评价右美托咪定和咪达唑仑对重症监护室(ICU)重症病人镇静治疗的有效性和安全性。方法检索中文数据库(中国知网、万方、维普、中国生物医学数据库(CBM))、英文数据库(PubMed、OVID、EMbase)和医学网站(Cochrane library、Clin⁃ical Trials.gov等),检索时限为建库至2018年2月28日,收集有关右美托咪定和咪达唑仑用于ICU重症病人镇静治疗的随机对照试验文献,制定纳入排除标准,采用Review Manager 5.3统计软件进行Meta分析。结果共纳入26篇文献(中文22篇,英文4篇),右美托咪定组1527例,咪达唑仑组1362例。在有效性方面,右美托咪定能明显减少病人机械通气时间(SMD=-0.92,95%CI:-1.24^-0.59,P<0.01)、入住ICU的时间(SMD=-0.70,95%CI:-0.97^-0.43,P<0.01)、住院时间(SMD=-0.67,95%CI:-1.32^-0.02,P<0.05),而在插管时间方面比较差异无统计学意义(P>0.05);在安全性方面,右美托咪定能明显减少病人谵妄的发生率(OR=0.26,95%CI:0.21~0.32,P<0.01)、呼吸抑制的发生率(OR=0.14,95%CI:0.08~0.25,P<0.01),但是右美托咪定会明显增加病人心动过缓的发生率(OR=1.48,95%CI:1.13~3.02,P<0.05),而在低血压的发生方面比较差异无统计学意义(P>0.05)。结论右美托咪定在安全性和有效性方面明显优于咪达唑仑,是临床上较为理想的镇静药物,但要加强用药期间发生心动过缓的不良反应监测。Objective To evaluate the safety and efficacy of dexmedetomidine and midazolam for sedation in intensive care unit(ICU)patients.Methods Retrieval of Chinese database(CNKI,Wangfang,VIP,CBM),English database(PubMed,OVID,EMbase)and Medical website(Cochrane library,Clinical Trials.gov)was conducted.The retrieval time limit is from the building of the database to February 28,2018.Literatures on randomized controlled trial of dexmedetomidine and midazolam in the sedation of critically ill patients in ICU were collected.Meta⁃analysis was performed by the statistical software Review Manager 5.3.Results A total of 26 studies were identified(22 in Chinese,4 in English),involving 1527 cases of dexmedetomidine group and 1362 cases of midazolam group.In terms of effectiveness,dexmedetomidine could significantly reduce the duration of mechanical ventilation(SMD=-0.92,95%CI:-1.24⁃-0.59,P<0.01),shorter the length of ICU stay(SMD=-0.70,95%CI:-0.97⁃-0.43,P<0.01)and the time of hospitalization(SMD=-0.67,95%CI:-1.32⁃-0.02,P<0.05),however,there was no significant difference in intubation time(P>0.05).In terms of safety,dexmedetomidine could significantly reduce the incidence of delirium(OR=0.26,95%CI:0.21⁃0.32,P<0.01)and the incidence of respiratory depression(OR=0.14,95%CI:0.08⁃0.25,P<0.01),but could significantly increase the incidence of bradycardia(OR=1.48,95%CI:1.13⁃3.02,P<0.05)There was no statistically significant difference in the occurrence of hypotension(P>0.05).Conclusion Dexmedetomidine is significantly better in terms of safety and efficacy than midazolam,and is an ideal sedative drug in clinic.However,it is necessary to enhance adverse reaction monitoring of the occurrence of brady⁃cardia during medication.

关 键 词：右美托咪定 咪达唑仑 麻醉和镇痛 重症监护 镇静 META分析 

分 类 号：R614[医药卫生—麻醉学]