右美托咪定对脓毒症机械通气患者机械通气时间及预后的影响

Effect of Dexmedetomidine on Duration of Mechanical Ventilation and Prognosis in Septic Patients Requiring Mechanical Ventilation

目的:探讨右美托咪定对脓毒症机械通气患者机械通气时间和预后的影响。方法:提取eICU协作研究数据库(eICU-CRD)中脓毒症机械通气患者的数据,根据使用镇静药物分为右美托咪定、丙泊酚、咪达唑仑三组。主要结局为ICU28天死亡率、机械通气时间,次要结局为住院死亡率、ICU住院时间、住院时间、谵妄发生率。使用Cox回归、逻辑回归和线性回归模型评估三组与结局之间的相关性。结果:共纳入1455例患者。与右美托咪定组相比,丙泊酚和咪达唑仑组的ICU28天死亡风险、住院死亡风险显著增高(P<0.01)。与右美托咪定组相比,丙泊酚组机械通气时间显著延长(P<0.01),而咪达唑仑组与机械通气时间无显著相关性。与右美托咪定组相比,丙泊酚组和咪达唑仑组与住院时间、ICU住院时间以及谵妄发生率之间无显著相关性。结论:对于脓毒症机械通气患者,使用右美托咪定相较于丙泊酚或咪达唑仑能够有效降低ICU28天死亡率和住院死亡率。同时,与丙泊酚相比,右美托咪定的使用还有助于缩短机械通气的时间。

Objective:To investigate the effects of dexmedetomidine on the duration of mechanical ventilation and prognosis in septic patients requiring mechanical ventilation.Methods:Data from septic patients on mechanical ventilation were extracted from the eICU Collaborative Research Database(eICU-CRD).Patients were divided into three groups based on the type of sedative used:dexmedetomidine,propofol,and midazolam.Primary outcomes were 28-day ICU mortality and duration of mechanical ventilation.Secondary outcomes included in-hospital mortality,ICU length of stay,hospital stay,and incidence of delirium.Cox regression,logistic regression,and linear regression models were used to assess the association between the three groups and outcomes.Results:A total of 1,455 patients were included in the study.Compared with the dexmedetomidine group,the propofol group and the midazolam group had a significantly increased risk of 28-day ICU mortality and in-hospital mortality(P<0.01).Compared with the dexmedetomidine group,the duration of mechanical ventilation was significantly prolonged in the propofol group(P<0.01),whereas no significant association was observed in the midazolam group.No significant correlations were found between the propofol and midazolam groups compared to the dexmedetomidine group regarding hospital stay,ICU stay,and incidence of delirium.Conclusion:In septic patients on mechanical ventilation,the use of dexmedetomidine,as opposed to propofol or midazolam,effectively reduces 28-day ICU mortality and in-hospital mortality.Dexmedetomidine also helps reduce the duration of mechanical ventilation compared with propofol.