雷米芬坦尼尔与德克斯梅德托米丁用于心脏手术患者的非侵入性通风不耐受:一个多中心随机对照试验
Guang-Wei Hao1, Jia-Qing Wu2, Shen-Ji Yu3
1Department of Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Journal of intensive care
|September 18, 2024
概括
雷米芬坦尼尔 (REM) 和德克斯梅德托米丁 (DEX) 在心脏手术患者的非侵入性通风 (NIV) 不耐受性方面显示出相似的初始缓解率. 然而,随着时间的推移,REM表现出优越性,不良事件较少.
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.
- 麻醉学 麻醉学
背景情况:
- 对于心脏手术患者的非侵入性通风 (NIV) 不耐受症的最佳镇静效果尚不清楚.
- 中度至重度的NIV不耐受性在术后护理中带来了挑战.
- 评估镇静剂的有效性和安全性对于患者的治疗结果至关重要.
研究的目的:
- 为了比较Remifentanil (REM) 与Dexmedetomidine (DEX) 的疗效和安全性,用于心脏手术患者的NIV不耐受.
- 评估NIV不耐受症的缓解率,并确定潜在的不良影响.
- 为了确定改善NIV耐受性的最佳镇静剂方案.
主要方法:
- 多中心,前性,单盲,随机对照研究.
- 179名患有中度至重度NIV不耐受症的成人心脏手术患者被随机分配到REM或DEX.
- 在72小时内使用四点评分评估NIV不耐受性;主要结局是缓解率.
主要成果:
- 在REM和DEX组之间,初始缓解率没有显著差异.
- 在考虑时间因子 (OR=3.31,p=0.009) 时,REM的表现明显优于DEX.
- 快速运动组没有报告任何不良反应,而DEX组有9例 (胸心跳,低血压);二次结果是可比的.
结论:
- 虽然最初的缓解率相似,但remifentanil与NIV不耐受性相比,随着时间的推移显示出优越的疗效.
- 雷米芬坦尼尔与更好的安全性相关,没有报告的不良事件.
- 这些发现表明,雷米芬坦尼尔可能是管理NIV不耐受症的首选镇静剂选择.
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