Ozaki Makoto, Takeda Junzo, Tanaka Keiji, Shiokawa Yasuhiro, Nishi Shinichi, Matsuda Kenichi, Doi Matsuyuki, Kakihana Yasuyuki, Fujino Yuji, Takinami Masanori, Kawai Misa
Department of Anesthesiology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
J Anesth. 2014 Feb;28(1):38-50. doi: 10.1007/s00540-013-1678-5. Epub 2013 Aug 3.
We evaluated the safety and efficacy of long-term administration of dexmedetomidine in patients in the intensive care unit (ICU). Primary endpoint was the incidence of hypotension, hypertension, and bradycardia. Secondary endpoints were withdrawal symptoms, rebound effects, the duration of sedation with Richmond Agitation-Sedation Scale (RASS) ≤ 0 relative to the total infusion time of dexmedetomidine, and the dose of additional sedatives or analgesics.
Dexmedetomidine 0.2-0.7 μg/kg/h was continuously infused for maintaining RASS ≤ 0 in patients requiring sedation in the ICU. Safety and efficacy of short-term (≤ 24 h) and long-term (>24 h) dexmedetomidine administration were compared.
Seventy-five surgical and medical ICU patients were administered dexmedetomidine. The incidence of hypotension, hypertension, and bradycardia that occurred after 24 h (long-term) was not significantly different from that occurring within 24 h (short-term) (P = 0.546, 0.513, and 0.486, respectively). Regarding withdrawal symptoms, one event each of hypertension and headache occurred after the end of infusion, but both were mild in severity. Increases of mean arterial blood pressure and heart rate after terminating the infusion of dexmedetomidine were not associated with the increasing duration of its infusion. The ratio of duration with RASS ≤ 0 was ≥ 85 % until day 20, except day 9 (70 %) and day 10 (75 %). There was no increase in the dose of additional sedatives or analgesics after the first 24-h treatment period.
Long-term safety of dexmedetomidine compared to its use for 24 h was confirmed. Dexmedetomidine was useful to maintain an adequate sedation level (RASS ≤ 0) during long-term infusion.
我们评估了在重症监护病房（ICU）患者中长期使用右美托咪定的安全性和有效性。主要终点是低血压、高血压和心动过缓的发生率。次要终点是戒断症状、反跳效应、相对于右美托咪定总输注时间，使用里士满躁动镇静量表（RASS）≤0的镇静持续时间，以及额外镇静剂或镇痛药的剂量。
对于ICU中需要镇静的患者，持续输注0.2 - 0.7μg/kg/h的右美托咪定以维持RASS≤0。比较了短期（≤24小时）和长期（>24小时）使用右美托咪定的安全性和有效性。
75名外科和内科ICU患者接受了右美托咪定治疗。24小时后（长期）发生的低血压、高血压和心动过缓的发生率与24小时内（短期）发生的发生率无显著差异（P分别为0.546、0.513和0.486）。关于戒断症状，输注结束后各发生1例高血压和头痛事件，但严重程度均较轻。停止输注右美托咪定后平均动脉血压和心率的升高与输注持续时间的增加无关。直到第20天，除第9天（70%）和第10天（75%）外，RASS≤0的持续时间比例≥85%。在第一个24小时治疗期后，额外镇静剂或镇痛药的剂量没有增加。
证实了右美托咪定长期使用与其使用24小时相比的安全性。右美托咪定在长期输注期间有助于维持适当的镇静水平（RASS≤0）。
