関連する実験動画
デックスメデトミジン vs ミダゾラーム,重症患者の鎮静剤:ランダム化試験
Richard R Riker1, Yahya Shehabi, Paula M Bokesch
1University of Vermont College of Medicine, USA. rikerr@mmc.org
JAMA
|February 4, 2009
まとめ
デックスメデトミジンとミダゾラムは,ICU患者の同等の鎮静効果を示した. しかし,デクスメデトミジンは,呼吸器の時間および妄想を短縮し,ブラジカルディアが主要な副作用であった.
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
- 集中治療室 (ICU) 鎮静治療
背景:
- ガンマアミノバター酸受容体アゴニスト薬は,ICUの標準的な鎮静剤です.
- アルファ (((2) アゴニストであるデックスメデトミジンは,従来の鎮静剤に比べて潜在的な利点を示しています.
研究 の 目的:
- デクスメデトミジンを用いた長期鎮静の有効性と安全性をミダゾラムと比較する.
- 機械呼吸器によるICU患者のアウトカムを評価する.
主な方法:
- 5カ国の68のセンターで375人のICU患者が参加した見通し,ダブルブラインド,ランダム化試験です.
- 患者はデクスメドテトミジンまたはミダゾラムのいずれかを投与され,軽静止薬 (RASS -2〜+1) に定位されました.
- 結果には,標的の鎮静範囲内の時間,妄想の有病率,呼吸器の持続時間,および有害事象が含まれていました.
主要な成果:
- デクセメトミジンとミダゾラームのグループ (77.3%対75.1%) の間で,ターゲットRASS範囲内の時間において有意な差はありません.
- デックスメデトミジンは,妄想発症の頻度 (54%対76.6%) とエクストゥベーションまでの時間 (3.7対5.6日) を著しく減少させた.
- ブラディカルディアはデクスメデトミジン (42.2% vs 18.9%) と比較してより一般的であったが,高血圧および高血圧はよりまれであった.
結論:
- デックスメデトミジンとミダゾラムは,機械呼吸器のICU患者で比較可能な鎮静レベルを提供します.
- デックスメデトミジンの使用は,メカニカル換気時間の短縮と妄想と関連しています.
- ブラディカルディアはデクスメデトミジンの顕著な副作用であり,注意深くモニタリングする必要があります.
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