用德克塞梅托米丁与洛拉泽帕姆镇静对机械通风患者急性脑功能障碍的影响:MENDS随机对照试验
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
概括
与洛拉泽帕姆相比,德克斯梅德托米丁改善了机械通风ICU患者的治疗结果. 接受德克斯梅德托米丁治疗的患者经历了更多的无 Delirium 或昏迷的日子,并有更好的镇静控制.
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.
- 神经科学是一个神经科学.
背景情况:
- 二胺是一种二胺,是ICU镇静的标准,但与痴呆症,长时间住院和死亡率有关.
- 德克斯梅德托米丁提供了一种替代的镇静方法,作用于不同的中枢神经系统受体,可能减少急性大脑功能障碍.
研究的目的:
- 为了比较德克斯梅德托米丁与洛拉泽帕姆在减少机械通风ICU患者的妄想和昏迷持续时间方面的疗效.
- 评估德克斯梅德托米丁与洛拉泽帕相比是否能提供足够的镇静作用.
主要方法:
- 一个双盲,随机对照试验,涉及106名机械通风ICU患者.
- 患者接受了达克斯梅托米丁或洛拉泽巴姆治疗长达120小时,并使用里士满兴奋镇静量表 (RASS) 监测镇静水平.
- 痴呆症每天评估两次,使用ICU的混评估方法 (CAM-ICU).
主要成果:
- 德克斯梅德托米丁的使用导致"没有妄想或昏迷的生存日数"显著增加 (中位数为7.0对3.0天,P = .01).
- 昏迷的患病率在使用德克斯梅德托米丁时较低 (63%与92%相比,P < .001).
- 接受德克斯梅德托米丁治疗的患者在目标镇静范围内的时间更长 (80% vs 67% 的天数,P = .04).
结论:
- 德克斯梅德托米丁输液改善了机械通风ICU患者的结局,导致更多的"没有妄想或昏迷的生存日".
- 与洛拉泽相比,德克斯梅德托米丁可以更好地控制镇静水平.
- 这项研究支持德克斯梅德托米丁作为一种有益的替代品,用于危急病患者的镇静.
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