创伤性脑损伤的早期镇静:一个多中心的国际观测研究
Giovanni Russo1, Anatole Harrois1,2, James Anstey1
1Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
概括
严重创伤性脑损伤 (TBI) 的镇静实践各不相同,其中propofol比midazolam更常见. 两种镇静剂的选择都没有独立影响60天死亡率,尽管受伤严重程度确实影响了选择.
科学领域:
- 神经临界护理是指神经临界护理.
- 创伤外科 手术 创伤外科
- 临床药理学 临床药理学
背景情况:
- 镇静对于管理严重创伤性脑损伤 (TBI) 患者与内压力监测至关重要.
- 了解镇静剂的选择,剂量和持续时间对于优化患者结果至关重要.
- 对于严重的TBI而言,目前使用镇静剂的做法在各种临床环境中还没有得到充分的描述.
研究的目的:
- 调查严重TBI患者的镇静剂使用情况.
- 分析镇静剂选择 (propofol与midazolam),剂量和持续时间与临床结果之间的关联.
- 为了确定影响这种患者群体中镇静剂选择的因素.
主要方法:
- 多国,多中心,回顾性观察性研究,涉及262名成人严重TBI患者.
- 收集关于使用的镇静剂,剂量,持续时间和患者人口统计数据的数据.
- 主要结局:60天死亡率;次要结局:ICU/住院时间长度,扩展格拉斯哥结局量表 (EGOS).
主要成果:
- 普罗波 (35.4%) 比米达佐拉姆 (25.6%) 更频繁地被用作第一线治疗.
- 米达佐拉姆的使用与阿片类药物的同时使用有很强的关联 (OR,12.9).
- 在调整损伤严重程度 (IMPACT,ISS) 后,两种镇静剂选择都与60天死亡率无独立关联.
结论:
- 普罗波福和米达佐拉姆是严重TBI的常见镇静剂,通常用高剂量.
- 镇静剂的选择受伤严重程度的影响,但不能独立预测60天的死亡率.
- 进一步的研究可能会探索根据TBI严重程度和患者因素量身定制的最佳镇静策略.
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