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  

Meta-analysis of efficacy and safety of sedative therapy with midazolam and dexmedetomidine/propofol in critically ill patients undergoing mechanical ventilation

作　　者：吴佳骞 苏丹[1] 邵腾皓 于占彪[1] 赵聪聪[2] 王迎鑫 WU Jiaqian;SU Dan;SHAO Tenghao;YU Zhanbiao;ZHAO Congcong;WANG Yingxin(Dept.of Intensive Care Medicine,the Affiliated Hospital of Hebei University,Hebei Baoding 071030,China;Dept.of Intensive Care Medicine,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050035,China)

机构地区：[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

出　　处：《中国药房》2024年第3期353-360,共8页China Pharmacy

基　　金：河北省科技计划项目(No.2022HBKJ00030);河北省卫生健康委医学科学研究课题(No.20211786)。

摘　　要：目的 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 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 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 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 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 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 A total of 31 literature were included,with a total of 2765 patients.Results of meta-analysis showed that the mechanical ventilation time[MD=14.13,95%CI(13.75,14.52),P<0.00001]and the length of hospitalization in the intensive care unit[MD=0.92,95%CI(0.54,1.30),P<0.00001]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<0.00001],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<0.00001]in midazolam group were higher than dexmedetomidine/propofol group.CONCLUSIONS 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.

关 键 词：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 

分 类 号：R971.3[医药卫生—药品] R614.21[医药卫生—药学]