咪达唑仑与右美托咪啶对照研究的回顾性分析

Retrospective report for the controlled trials of dexmedetomidine versus midazolam

目的:收集2009~2015年发表的有关右美托咪啶与咪达唑仑之间随机对照研究进行分析,进一步验证右美托咪啶与咪达唑仑的镇静效果及对机械通气时间、ICU住院时间等的影响。方法:主要对PubMedmedline、ovid-embase、Cochrane Library进行检索,纳入标准为针对ICU成人患者使用右美托咪啶与咪达唑仑镇静治疗的随机对照试验。运用Review Manager 5.0软件进行统计分析,连续性变量采用加权均数差WMD及其95%CI表示,二分类变量资料采用相对危险度RR及其95%CI表示,率的比较采用方差倒数分析。结果:镇静目标达标时间百分比比较差异无统计学意义(WMD=0.03,95%CI:-0.01~0.07,P=0.1);右美托咪啶组能缩短机械通气时间(WMD=-32.35,95%CI:-46.41^-18.29,P<0.05);ICU住院时间更短(WMD=-40.82,95%CI:-43.10^-38.54,P<0.05);心动过缓发生率更高(RR=2.49,95%CI:1.79~3.46,P<0.05);低血压发生率比较差异无统计学意义(RR=1.20,95%CI:0.73~1.95,P=0.48)。结论:右美托咪啶能产生与咪达唑仑相同的镇静效果,同时缩短机械通气时间及ICU住院时间,但其产生心动过缓的不良反应也应予以关注。

Objective：Analyze the randomized-controlled trials of dexmedetomidine versus midazolam that published between 2009 to 2015.And validate the two sedatives＇ efficacy,and the impact to duration of mechanical ventilation and length of ICU stay.Method：Studies were independently searched in Pubmed-medline、ovid-embase、and cochrane library.The randomized-controlled trials of dexmedetomidine versus midazolam were selected.Analysis was performed with Review Manager version 5.3.Continuous outcomes were demonstrated by the style of weight mean difference（WMD）with 95% confidence interval（CI）.Then dichotomous outcomes were demonstrated by the style of risk ratio（RR）with 95%CI.Rate outcomes were demonstrated by the style of generic inverse variance.Result：There was no difference in percentage of time within the sedation target [WMD =0.03,95%CI（-0.01,0.07）,P=0.1].In dexmedetomidine-treated patients,duration of mechanical ventilation was shorter[WMD=-32.35,95%CI（-46.41,-18.29）,P〈0.05],the same as length of ICU stay[WMD=-40.82,95%CI（-43.10,-38.54）,P〈0.05].But there was higher incidence of bradycardia [RR=2.49,95%CI（1.79,3.46）,P〈0.05]while no difference in incidence of hypotension[RR=1.20,95%CI（0.73,1.95）,P=0.48].Conclusion：Dexmedetomidine has the similar efficacy versus midazolam,while shorten duration of mechanical ventilation and length of ICU stay.The adverse reaction such as bradycardia should also be paid attention to.