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首页> 外文期刊>Current therapeutic research, clinical and experimental. >Sedation During Noninvasive Mechanical Ventilation With Dexmedetomidine or Midazolam: A Randomized, Double-Blind, Prospective Study
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Sedation During Noninvasive Mechanical Ventilation With Dexmedetomidine or Midazolam: A Randomized, Double-Blind, Prospective Study

机译：右美托咪定或咪达唑仑在无创机械通气中的镇静作用：一项随机，双盲，前瞻性研究

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BACKGROUND: Effective noninvasive mechanical ventilation (NIV) requires a patient to be comfortable and in synch with the ventilator, for which sedation is usually needed. Choice of the proper drug for sedation can lead to improved clinical outcomes.OBJECTIVE: The aim of this study was to compare the effectiveness of dexmedetomidine and midazolam on sedation and their effects on hemodynamics and gas exchange.METHODS: In this randomized, double-blind study, intensive care unit patients with acute respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease undergoing NIV were equally randomized to receive a loading dose of1 mug/kg IV dexmedetomidine or 0.05 mg/kg midazolam over 10 minutes followed by a maintenance infusion of 0.5 mug/kg/h dexmedetomidine (group D) or 0.1 mg/kg/h midazolam (group M). The following parameters were measured by a blinded clinician at baseline and 1, 2, 4, 6, 8, 12, and 24 hours after the loading dose was administered: Ramsay Sedation Score (RSS), Riker Sedation-Agitation Scale (RSAS), Bispectral Index (BIS), arterial blood gases, and vital signs. A second blinded investigator determined dosing changes according to the outcome of maintaining a target sedation level of RSS 2 to 3, RSAS 3 to 4, and BIS >85.RESULTS: A total of 45 patients were assessed for enrollment in the study; 4 did not meet the inclusion criteria and 1 refused to participate (men/women 19/21; mean age 58/60; all patients were receiving bronchodilators, steroids, antibiotics, and mucolytics). In both groups (n = 20), RSS significantly increased and RSAS levels and BIS values significantly decreased after the loading dose, compared with baseline (P < 0.05). RSS levels were significantly lower beginning at 4 hours in group D compared with group M (P < 0.05). RSAS levels were not significantly different between the2 groups in the first 8 hours. However, RSAS levels were significantly higher at 8 hours after the loading dose was administered in group D compared with group M (P < 0.01). BIS was significantly higher in group D throughout the study period (P < 0.05). Respiratory rates and gas exchange values were not significantly different between the 2 groups. The number of times a change in infusion dose was needed was significantly lower in group D (2 patients with 1 change each) than in group M (3 patients with 1 change, 1 patient with 2 changes, and 3 patients with 3 changes each) (P < 0.01).CONCLUSIONS: Dexmedetomidine and midazolam are both effective sedatives for patients with NIV. Dexmedetomidine required fewer adjustments in dosing compared with midazolam to maintain adequate sedation.
机译：背景：有效的非侵入性机械通气（NIV）要求患者舒适且与呼吸机同步，为此通常需要镇静。目的：选择合适的镇静药物可以改善临床效果。目的：本研究的目的是比较右美托咪定和咪达唑仑对镇静的效果以及它们对血液动力学和气体交换的影响。方法：在此随机，双盲研究中研究显示，因NIV引起的慢性阻塞性肺疾病急性加重而导致急性呼吸衰竭的重症监护病房患者，均被随机分配在10分钟内接受1杯/千克静脉注射右美托咪定或0.05毫克/千克咪达唑仑的负荷剂量，然后持续输注0.5杯/千克/小时的右美托咪定（D组）或0.1毫克/千克/小时的咪达唑仑（M组）。盲人的临床医生在基线和给药剂量给药后的1、2、4、6、8、12和24小时测量以下参数：Ramsay镇静评分（RSS），Riker镇静激动量表（RSAS），双光谱指数（BIS），动脉血气和生命体征。另一位不知情的研究者根据维持目标镇静水平RSS 2至3，RSAS 3至4和BIS> 85的结果确定了剂量变化。结果：共有45名患者被纳入研究。 4名不符合入选标准，1名拒绝参加（男性/女性19/21;平均年龄58/60;所有患者均接受支气管扩张药，类固醇，抗生素和粘液溶解剂）。与基线相比，两组（n = 20）的RSS显着升高，RSAS水平和BIS值显着降低（P <0.05）。 D组从4小时开始的RSS水平明显低于M组（P <0.05）。在最初的8小时中，两组之间的RSAS水平没有显着差异。然而，与M组相比，D组在施加负荷剂量后8小时的RSAS水平显着更高（P <0.01）。在整个研究期间，D组的BIS显着较高（P <0.05）。两组之间的呼吸频率和气体交换值无显着差异。 D组（2位患者，每组1处变更）需要改变输注剂量的次数明显低于M组（3位患者，每组1处变更，1位患者2处变更，3位患者各3处变更） （P <0.01）。结论：右美托咪定和咪达唑仑均为NIV患者的有效镇静剂。与咪达唑仑相比，右美托咪定对剂量的调整较少，以维持足够的镇静作用。

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