- 期刊
右美托咪定與其他鎮靜劑在機械通氣重症病人的成效與差異：系統性文獻回顧與統合分析
Effects of Dexmedetomidine Compared with Other Sedative Drugs in Intensive Care Unit Patients on Mechanical Ventilation: Systematic Review and Meta-Analysis
摘要
鎮靜劑對機械通氣重症病人的影響，仍有很多不確定性。本研究目的在評估右美托咪定（dexmedetomidine）與其他常見重症加護病房鎮靜藥物，如咪達唑侖（midazolam）、丙泊酚（propofol）和羅拉西泮（lorazepam）的有效性與安全性。從全文資料庫（1999年至2023年）中檢索了中英文的隨機對照研究，使用Cochrane誤差風險工具2.0評讀10篇隨機對照研究（1,526位受試者）。研究結果顯示右美托咪定在降低譫妄發生率及機械通氣時間，達統計上顯著差異，但增加心搏過緩的風險；在血壓方面，右美托咪定比咪達唑侖，增加低血壓的發生率，但與丙泊酚或整體（咪達唑侖／丙泊酚）相比，兩組未達統計上差異。因此，對於高風險譫妄的機械通氣重症病人，建議使用右美托咪定，儘管會增加心血管不良事件的風險，除非病人有嚴重心臟傳導阻滯或低血壓問題，否則在考量治療利弊效果，減少譫妄發生率被認為比心搏過緩和低血壓的發生率更為重要。醫護人員應密切監測心血管指標，或降低右美托咪定的輸注速度，和避免推注來預防心搏過緩和低血壓的風險。
並列摘要
The effects of various sedatives on mechanically ventilated patients remain uncertain. This study evaluated the efficacy and safety of dexmedetomidine compared with other sedatives commonly used in intensive care units (ICUs), including midazolam, propofol, and lorazepam. A systematic review and meta-analysis of randomized controlled trials published in Chinese and English from 1999 to 2023 was performed that involved 10 randomized controlled trials with 1,526 patients in total. The Cochrane Risk of Bias 2.0 tool was used for assessment. The analysis revealed that dexmedetomidine significantly reduced the occurrence of delirium and the duration of mechanical ventilation but increased the risk of bradycardia. Regarding hypotension, dexmedetomidine resulted in significantly higher incidence compared with midazolam, but no significant difference was found when compared with propofol or the combined group (midazolam + propofol). For mechanically ventilated patients at high risk of delirium, dexmedetomidine is recommended despite its cardiovascular risks because reducing delirium is prioritized over the potential for bradycardia and hypotension. However, caution is advised in patients with severe atrioventricular block or hypotension. Health-care providers should closely monitor adverse cardiovascular effects, adjust the infusion rate of dexmedetomidine, and avoid bolus administration to reduce the risks of bradycardia and hypotension.