右美托咪啶和丙泊酚對術后ICU患者鎮靜效果的系統評價_《中國循證醫學雜志》

作者：

卓帥 , 鄭劍橋 ,  劉斌

四川大學華西醫院麻醉科（成都?610041）;

關鍵詞：

右美托咪啶丙泊酚加強監護病房（ICU）鎮靜系統評價 Meta分析

DOI：

10.7507/1672-2531.20120112

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目的系統評價右美托咪啶和丙泊酚對術后ICU患者的鎮靜、鎮痛效果和不良反應。
方法計算機檢索Cochrane Library、PubMed、SCI、SpringerLinker、ScinceDirect、CNKI、VIP、WanFang Data、CBM等數據庫，檢索時限均從建庫至2011年11月，收集所有右美托咪啶和丙泊酚對術后ICU患者鎮靜鎮痛效果的隨機對照試驗（RCT），由2位研究者對納入研究進行資料提取和質量評價后，采用RevMan 5.1軟件進行Meta分析。
結果共納入10個RCT，793例患者。定性分析結果顯示，在一定劑量范圍內［右美托嘧啶：0.2～2.5 μg/（kg·h），丙泊酚：0.3～4.5 mg/（kg·h）］，右美托嘧啶和丙泊酚提供治療所需鎮靜效果相似。鎮靜治療時，右美托咪啶組需追加的鎮痛藥劑量少于丙泊酚組。Meta分析結果顯示：鎮靜治療期間，右美托咪啶組需追加鎮痛藥的人數比例少于丙泊酚組［OR=0.24，95%CI（0.08，0.68），P=0.008］；與丙泊酚相比，右美托咪啶能顯著減少患者ICU入住時間［WMD= –1.10，95%CI（–1.88，–0.32），P=0.006］，但不能減少患者機械通氣時間［WMD=0.89，95%CI（–1.15，2.93），P=0.39］；鎮靜治療期間，兩組患者不良反應（心動過緩及低血壓）發生率差異無統計學意義［心動過緩OR=3.57，95%CI（0.86，14.75），P=0.08；低血壓OR=1.00，95%CI（0.30，3.32），P=1.00］；與右美托咪啶相比，丙泊酚可能更容易引起鎮靜期間的呼吸抑制，但該結果尚需進一步研究。鎮靜治療后，兩組患者病死率差異無統計學意義［OR=1.03，95%CI（0.54，1.99），P=0.92］。
結論在一定劑量范圍內，右美托咪啶具有與丙泊酚相似的鎮靜效果，兼有鎮痛作用，可節約鎮痛藥用量，并可減少患者的ICU入住時間，且較少發生不良反應和呼吸抑制。鑒于本系統評價樣本量有限，納入研究質量不高，所得結論尚需開展更多設計嚴謹的大樣本隨機對照試驗加以驗證。
關鍵詞右美托咪啶；丙泊酚；加強監護病房（ICU）；鎮靜；系統評價；Meta分析

引用本文： 卓帥,鄭劍橋,劉斌. 右美托咪啶和丙泊酚對術后ICU患者鎮靜效果的系統評價. 中國循證醫學雜志, 2012, 12(6): 686-693. doi: 10.7507/1672-2531.20120112 復制

1.	阮靜, 皋源. 右旋美托咪啶在重癥監護病室鎮靜鎮痛中的應用. 醫學綜述, 2008, 14(12): 1898-1900.
2.	Claeys MA, Gepts E, Camu F, et al. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth, 1988, 60(1): 3-9.
3.	Aitkenhead AR, Pepperman ML, Willatts SM, et al. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet, 1989, 2(8665): 704-709.
4.	Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. Crit Care Clin, 1995, 11(4): 827-847.
5.	Leino K, Mildh L, Lertola K, et al. Time course of changes in breathing pattern in morphine and oxycodone induced respiratory depression. Anaesthesia, 1999, 54(9): 835-840.
6.	Kamibayashi T, Maze M. Clinical uses of alpha 2-adrenergic agonists. Anesthesiology, 2000, 93(5): 1345-1350.
7.	Judith E, Tonny D, Jill A, et al. Sedative, amnestic,and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg, 2000, 90(3): 699-705.
8.	Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/ midazolam for long-term sedation during mechanical ventilation. Intensive Care Med, 2009, 35(2): 282-290.
9.	李民, 張利萍, 吳新民. 右美托咪啶在臨床麻醉中應用的研究進展. 中國臨床藥理學雜志, 2007, 23(6): 466-470.
10.	Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of Dexmedetomidine Versus Propofol-based Sedation Therapy in Mechanically Ventilated Cardiac Surgery Patients at a Tertiary Academic Medical Center. Crit Pathw Cardiol, 2010, 9(4): 221-226.
11.	Memis D, Kargi M, Sut N, et al. Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study. J Crit Care, 2009, 24(4): 603-608.
12.	Tasdogan M, Memis D, Sut N, et al. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth, 2009, 21(6): 394-400.
13.	Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
14.	Kaneko T. Postoperative management of carotid endarterectomy with dexmedetomidine-a comparison with propofol. Masui, 2009, 57(6): 696-703.
15.	Memis D, Dökmeci D, Karamanlio?lu B, et al. A comparison of the effect on gastric emptying of propofol or dexmedetomidine in critically ill patients: preliminary study. Eur J Anaesthesiol, 2006, 23(8): 700-704.
16.	Corbett SM, Rebuck JA, Greene CM, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
17.	Elbaradie S, El Mahalawy FH, Solyman AH, et al. Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. J Egypt Natl Cancer Inst, 2004, 16(3): 153-158.
18.	Herr DL, Sum-Ping ST, England M, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
19.	Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit patient and clinician perceptions. Br J Anaesth, 2001, 87(5): 684-690.
20.	J.G Reves, Peter S.A. Glass, David A Lubarsky, et al. Miller’s Anesthesia: Intravenous Anesthetics. 7th Edition. Churchill Livingstone: elsevier, 2010.
21.	Correa-Sales C, Rabin BC, Maze M, et al. A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. Anesthesiology, 1992, 76(6): 948-952.
22.	Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery, 2005, 57(1): 1-10.
23.	Eisenach JC, De Kock M, Klimscha W, et al. Alpha 2 agonists and analgesia. Exp Opin Invest Drμgs, 1994, 3(10): 1005-1010.

1. 阮靜, 皋源. 右旋美托咪啶在重癥監護病室鎮靜鎮痛中的應用. 醫學綜述, 2008, 14(12): 1898-1900.
2. Claeys MA, Gepts E, Camu F, et al. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth, 1988, 60(1): 3-9.
3. Aitkenhead AR, Pepperman ML, Willatts SM, et al. Comparison of propofol and midazolam for sedation in critically ill patients. Lancet, 1989, 2(8665): 704-709.
4. Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. Crit Care Clin, 1995, 11(4): 827-847.
5. Leino K, Mildh L, Lertola K, et al. Time course of changes in breathing pattern in morphine and oxycodone induced respiratory depression. Anaesthesia, 1999, 54(9): 835-840.
6. Kamibayashi T, Maze M. Clinical uses of alpha 2-adrenergic agonists. Anesthesiology, 2000, 93(5): 1345-1350.
7. Judith E, Tonny D, Jill A, et al. Sedative, amnestic,and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg, 2000, 90(3): 699-705.
8. Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/ midazolam for long-term sedation during mechanical ventilation. Intensive Care Med, 2009, 35(2): 282-290.
9. 李民, 張利萍, 吳新民. 右美托咪啶在臨床麻醉中應用的研究進展. 中國臨床藥理學雜志, 2007, 23(6): 466-470.
10. Anger KE, Szumita PM, Baroletti SA, et al. Evaluation of Dexmedetomidine Versus Propofol-based Sedation Therapy in Mechanically Ventilated Cardiac Surgery Patients at a Tertiary Academic Medical Center. Crit Pathw Cardiol, 2010, 9(4): 221-226.
11. Memis D, Kargi M, Sut N, et al. Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study. J Crit Care, 2009, 24(4): 603-608.
12. Tasdogan M, Memis D, Sut N, et al. Results of a pilot study on the effects of propofol and dexmedetomidine on inflammatory responses and intraabdominal pressure in severe sepsis. J Clin Anesth, 2009, 21(6): 394-400.
13. Maldonado JR, Wysong A, van der Starre PJ, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics, 2009, 50(3): 206-217.
14. Kaneko T. Postoperative management of carotid endarterectomy with dexmedetomidine-a comparison with propofol. Masui, 2009, 57(6): 696-703.
15. Memis D, Dökmeci D, Karamanlio?lu B, et al. A comparison of the effect on gastric emptying of propofol or dexmedetomidine in critically ill patients: preliminary study. Eur J Anaesthesiol, 2006, 23(8): 700-704.
16. Corbett SM, Rebuck JA, Greene CM, et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med, 2005, 33(5): 940-945.
17. Elbaradie S, El Mahalawy FH, Solyman AH, et al. Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. J Egypt Natl Cancer Inst, 2004, 16(3): 153-158.
18. Herr DL, Sum-Ping ST, England M, et al. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth, 2003, 17(5): 576-584.
19. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit patient and clinician perceptions. Br J Anaesth, 2001, 87(5): 684-690.
20. J.G Reves, Peter S.A. Glass, David A Lubarsky, et al. Miller’s Anesthesia: Intravenous Anesthetics. 7th Edition. Churchill Livingstone: elsevier, 2010.
21. Correa-Sales C, Rabin BC, Maze M, et al. A hypnotic response to dexmedetomidine, an alpha 2 agonist, is mediated in the locus coeruleus in rats. Anesthesiology, 1992, 76(6): 948-952.
22. Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery, 2005, 57(1): 1-10.
23. Eisenach JC, De Kock M, Klimscha W, et al. Alpha 2 agonists and analgesia. Exp Opin Invest Drμgs, 1994, 3(10): 1005-1010.

《中國循證醫學雜志》

右美托咪啶和丙泊酚對術后ICU患者鎮靜效果的系統評價

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《中國循證醫學雜志》

右美托咪啶和丙泊酚對術后ICU患者鎮靜效果的系統評價

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