丙泊酚联合咪达唑仑在机械通气患者镇静效果的荟萃分析

发布时间：2018-06-17 10:44

本文选题：镇静 + 咪达唑仑　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:ICU(Intensive Care Unit)中各种危重患者常出现呼吸功能衰竭,在其救治过程中,有效的机械通气在治疗措施中尤其重要。但重症患者在机械通气治疗中常受各种因素的影响,导致患者出现焦虑、紧张、恐惧、烦躁不安、人机对抗等不良反应,从而导致病情加重恶化。因此镇静已成为ICU患者机械通气的常规治疗。在众多镇静药物中,丙泊酚和咪达唑仑是最为常用的镇静药,但单独使用时均存在一些不良反应,为了比较传统ICU镇静剂咪达唑仑和丙泊酚联合咪达唑仑疗效及其不良反应,我们采用系统评价的方法收集、评价、综合分析全球范围内有关丙泊酚联合咪达唑仑与咪达唑仑单用比较的随机对照试验(Randomized Controlled Trial RCT),以期为其临床应用提供证据。方法:计算机检索从建库开始直至2016年12月的相关期刊论文(China National Knowledge Infrastructure CNKI)、中国科技期刊数据库、万方数据库、PubMed、Cochrane Database of Systematic Reviews、Embase。中文检索词为:丙泊酚、咪达唑仑、机械通气、重症护理单元。英文检索词为:propofol、midazolam、mechanical ventilation、intensive care unit。并对被选中文章的参考文章和其他相关文献进行了二次检索,尽可能避免遗漏。对纳入文献进行资料提取,并评价文献质量,然后按干预措施不同分为咪达唑仑联合丙泊酚组和咪达唑仑组。采用Reman5.3软件进行统计,计算出各组数据均数差(Mean Difference MD)、比值比(Odds Ratio OR)、95%可信区间(Confidence Interval CI),并绘制森林图。结果:最终纳入15篇随机对照研究。共13篇文献包括908例患者报道了咪达唑仑联合丙泊酚与单用咪达唑仑对镇静起效时间的影响,表明与咪达唑仑组相比,咪达唑仑+丙泊酚镇静起效更快。共13篇文献包括1068例患者报道了咪达唑仑联合丙泊酚与单用咪达唑仑对达到满意镇静效果时间的比较,表明咪达唑仑联合丙泊酚组达到满意镇静效果时间更短。共12篇文献包括868例患者报道了咪达唑仑联合丙泊酚与单用咪达唑仑对镇静后苏醒时间的比较,表明咪达唑仑联合丙泊酚组镇静后患者苏醒所需时间更短。共11篇文献包括813例患者报道了咪达唑仑联合丙泊酚组不良反应发生率更低。结论:咪达唑仑联合丙泊酚应用使镇静起效迅速、达到目标镇静深度所需时间缩短、停用镇静药物后患者恢复快、不良反应发生率低,明显改善了咪达唑仑单独应用的安全性、有效性和经济性,是ICU患者中一项较好的镇静策略。
[Abstract]:Objective Respiratory failure often occurs in critical patients with different types of critical care unit. Effective mechanical ventilation is especially important in the treatment of respiratory failure. However, severe patients are often affected by various factors in mechanical ventilation treatment, leading to anxiety, tension, fear, restlessness, man-machine confrontation and other adverse reactions, which lead to the worsening of the condition. Sedation has become the routine treatment of mechanical ventilation in ICU patients. Among the many sedatives, propofol and midazolam are the most commonly used sedatives, but there are some adverse reactions when they are used alone. In order to compare the efficacy and adverse reactions of traditional ICU sedatives, midazolam and propofol combined with midazolam, In order to provide evidence for clinical application, we collected, evaluated and analyzed the randomized controlled trial (Randomized controlled trial) of propofol combined midazolam and midazolam in the world. Methods: the full text database of China National knowledge Infrastructure (CNKI), China National knowledge Infrastructure (CNKI), Chinese Journal of Science and Technology (CNKI) database, PubMedine Cochrane Database of Systematic Reviews (DBR) and EmbaseBase (EmbaseBase) were searched by computer from the beginning of the database construction until December 2016. Chinese key words: propofol, midazolam, mechanical ventilation, intensive care unit. The key words in English are: propofolia midazolamie mechanical ventilation and intensive care unit. The selected reference articles and other related documents are retrieved twice to avoid omissions as far as possible. The data were extracted and the quality of literature was evaluated. According to the intervention measures, midazolam combined with propofol and midazolam were divided into two groups: midazolam combined with propofol and midazolam. Reman5.3 software was used to calculate the mean difference of data in each group. The ratio was 95% confidence interval and forest map was drawn. Results: 15 randomized controlled trials were included. The effects of midazolam combined with propofol and midazolam alone on the onset time of sedation were reported in a total of 908 patients. The results showed that midazolam propofol was more effective than midazolam group. A total of 13 articles including 1068 patients reported the comparison of midazolam combined with propofol and midazolam alone to achieve satisfactory sedation time, which indicated that midazolam combined with propofol group had a shorter time to achieve satisfactory sedation effect. A total of 12 articles including 868 patients reported the comparison between midazolam combined with propofol and midazolam alone in the recovery time after sedation, indicating that midazolam combined with propofol had a shorter recovery time after sedation. A total of 11 articles including 813 patients reported a lower incidence of adverse reactions in midazolam combined with propofol group. Conclusion: midazolam combined with propofol can improve the safety of midazolam alone. Effectiveness and economy are a good sedative strategy in ICU patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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