デクセメトミジンとロラゼパムの鎮静薬による急性脳機能不全による機械呼吸器患者の効果:MENDSランダム化対照試験
Pratik P Pandharipande1, Brenda T Pun, Daniel L Herr
1Department of Anesthesiology/Division of Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. pratik.pandharipande@vanderbilt.edu
JAMA
|December 13, 2007
まとめ
デックスメデトミジンは,ロラゼパムと比較して,機械呼吸器のICU患者のアウトカムを改善しました. デクスメデトミジンを投与した患者は,妄想や昏睡のない日数が多く,鎮静のコントロールが良くなった.
科学分野:
- クリティカルケア・メディシン
- 薬理学 薬理学とは
- 神経科学は神経科学である.
背景:
- ベンゾジアゼピンであるロラゼパムはICUの鎮静剤の標準ですが,妄想,長期の入院,死亡率に関連しています.
- デックスメデトミジンは,異なる中枢神経系の受容体に作用し,潜在的に急性脳機能障害を軽減する代替的鎮静法を提供します.
研究 の 目的:
- 機械呼吸器によるICU患者における妄想および昏睡期間を短縮するにおけるデキスメデトミジンとロラゼパムの有効性を比較する.
- デクセメトミジンがロラゼパムと比較して適切な鎮静効果をもたらすかどうかを評価する.
主な方法:
- ダブルブラインド,ランダム化制御試験で,機械呼吸器を施したICU患者106人が参加した.
- 患者は120時間までデクメデトミジンまたはロラゼパムを投与され,リッチモンド興奮鎮静スケール (RASS) を使用して鎮静レベルが監視されました.
- 妄想はICUの混乱評価方法 (CAM-ICU) を使用して1日2回評価されました.
主要な成果:
- デキスメデトミジンの使用により",妄想や昏睡のない生存日数"が著しく増加しました (平均7.0対3.0日,P=0.01).
- コマの発生率はデクスメデトミジンで低かった (63%対92%,P <.001).
- デキスメデトミジンを投与した患者は,標的の鎮静範囲内でより多くの時間を過ごしました (80% vs. 67% の日数,P = .04).
結論:
- デキスメデトミジンの注入は,機械呼吸器のICU患者のアウトカムを改善し",妄想や昏睡のない生存日"を増加させた.
- デックスメデトミジンは,ロラゼパムと比較して,鎮静レベルをより良く制御した.
- この研究は,重症で呼吸器を施している患者の鎮静剤の有益な代替品としてデクスメデトミジンを支持しています.
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