重症监护室的镇静:一个系统的审查
M E Ostermann1, S P Keenan, R A Seiferling
1Department of Medicine, University of Western Ontario, Canada.
JAMA
|March 25, 2000
概括
普罗波提供有效的镇静和比米达佐拉姆更快的输出,但存在风险. 需要更多的研究来比较重症患者的镇静剂,优化机械通风和ICU停留.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 基于证据的实践.
背景情况:
- 在重症监护中,镇静对于患者的舒适至关重要.
- 然而,镇静剂可能会产生不良影响,并延长机械通风,增加医疗保健成本.
研究的目的:
- 为了比较不同的镇静方法,以获得最佳的患者结果.
- 确定镇静策略,尽量减少机械通风持续时间和重症监护室 (ICU) 停留时间.
主要方法:
- 1980年至1998年6月期间发表的随机对照试验 (RCT) 的系统综述和元分析.
- 在MEDLINE,EMBASE,Cochrane数据库和麻醉学期刊上进行了搜索.
- 包括RCT比较至少两种镇静剂在需要机械通风的成年患者.
主要成果:
- 32个RCT满足了标准,比较了包括普罗波福和米达佐拉姆在内的各种药物.
- 普罗波的镇静效果与米达佐拉姆的镇静效果相似,输出时间更快,但降低血压风险和成本增加.
- 有限的数据存在于ICU停留的长度; 异氨酸和胺在特定情况下显示了潜在的优势.
结论:
- 普罗波是一种可行的替代品midazolam 短期镇静,平衡有效性与潜在的副作用.
- 进一步高质量的RCT对于确定短期和长期重症监护镇静的最佳镇静剂至关重要.
- 证据不足以指导基于ICU停留时间的镇静剂选择.
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