丙泊酚与咪唑安定对ICU机械通气患者镇静疗效的国内文献Meta分析

Meta-analysis of studies on sedative effects of propofol and midazolam on mechanically ventilated patients in ICU

目的系统评价丙泊酚和咪唑安定在ICU机械通气患者中的镇静效果差异。方法检索公开发表的关于丙泊酚与咪唑安定用作ICU机械通气患者镇静的所有随机对照试验，按co．chrane系统评价方法，并采用Rev-Man5．0软件进行Meta分析。结果共纳入9个研究，包括758例患者。Meta分析结果显示，丙泊酚组与咪唑安定组相比起效时间快（P〈0．05），从给药到达到所需的镇静强度时间短（P〈0．05），停药后患者恢复清醒较快（P〈0．05），停药后再入睡的发生率低（P〈0．05），停药后恶心发生率低（P〈0．05），但血压下降的发生率高于咪唑安定组（P〈0．05）。结论丙泊酚作为ICU机械通气患者镇静用药与咪唑安定相比有优势，除了血压下降的发生率高于咪唑安定组以外，丙泊酚有良好的临床效果和安全性。

Objective To study the difference of sedative effects between propofol and midazolam on ICU patients with mechanical ventilation. Methods All randomized controlled trials （RCTs） about propofol as of sedative drug compared with midazolam were identified. Meta-analysis was performed by using the statistical software RevMan 5.0 on the basis of strict quality evaluation. Results Nine RCTs involving 1072 patients were included. The results of Meta-analysis showed that propofol was faster than midazolam in onset time, satisfactory sedative time and recovery time from sedation （ P 〈 0.05 ）, and reduced the sleep incidence or nausea incidence after discontinuation（ P 〈 0.05 ）, but the occurrence of hypotention with propofol was higher than midazolam （ P 〈 0.05 ）. Conclusion Significant advantages in favour of propofol as sedation during mechanical ventilation in ICU are observed. Propofol is safer than midazolam except for higher incidence of hypotension.