瑞马唑仑用于ICU机械通气患者的安全性和有效性

Efficacy and safety of remimazolam for sedation in mechanically ventilated ICU patients

目的比较瑞马唑仑与右美托咪定、咪达唑仑对重症监护室(ICU)机械通气患者的安全性和有效性。方法筛选连云港市第一人民医院和连云港市市立东方医院的ICU接受机械通气治疗的成年患者,并随机分为瑞马唑仑组、咪达唑仑组、右美托咪组。通过Richmond躁动-镇静评分(RASS)来调整药物剂量以控制患者处于浅镇静。观察患者的浅镇静达标时间和浅镇静的达标率以及低血压、心动过缓、呼吸抑制及谵妄的发生率。结果有效性方面,瑞马唑仑组的浅镇静达标时间短于右美托咪定组和咪达唑仑组[(25.4±5.4)min vs(28.7±7.3)min vs(30.6±4.7)min;P<0.05],浅镇静达标率高于咪达唑仑组(71.4%vs 45.5%;P<0.05)。安全性方面,瑞马唑仑组谵妄和呼吸抑制的发生率低于咪达唑仑组(17.2%vs 34.8%,18.3%vs 34.8%;P<0.05),心动过缓的发生率低于右美托咪定组(14.0%vs 30.3%;P<0.05)。结论瑞马唑仑用于ICU机械通气患者起效快于右美托咪定和咪达唑仑,镇静深度可控性高于咪达唑仑,且不良反应更少。

Objective To compare the safety and efficacy of remimazolam,dexmedetomidine and midazolam in mechanically ventilated ICU patients.Methods Adult patients receiving mechanical ventilation in the ICUs of First People's Hospital of Lianyungang and Lianyungang Oriental Hospital were screened and randomly divided into remimazolam group,midazolam group and dexmedetomidine group.Medication doses were adjusted to achieve target sedation goals according to RASS scores.The primary outcomes included the sedation standard time after medication and percentage of time within target RASS range,as well as the incidence of hypotension,bradycardia,respiratory depression and delirium.Results The sedation standard time after medication in the remimazolam group was shorter than that in the dexmedetomidine group and midazolam group[(25.4±5.4)min vs(28.7±7.3)min vs(30.6±4.7)min;P<0.05].The percentage of time within the target RASS range was higher than midazolam group(71.4%vs 45.5%;P<0.05).The prevalence of delirium and respiratory depression during treatment in remimazolam-treated patients was lower than that in midazolam-treated patients(17.2%vs 34.8%,18.3%vs 34.8%;P<0.05).Remimazolam-treated patients were less likely to develop bradycardia than dexmedetomidine-treated patients(14.0%vs 30.3%;P<0.05).Conclusion Among mechanically ventilated patients who were being treated with recommended light-sedation approaches,remimazolam-treated patients achieve the target sedation earlier than dexmedetomidine-treated patients and midazolam-treated patients.Moreover,remimazolam can improve the compliance rate of patients who were being treated with recommended light-sedation approaches,and can reduce the adverse reactions in patients.