Gao Yang, Kang Kai, Liu Haitao, Jia Liu, Tang Rong, Zhang Xing, Wang Hongliang, Yu Kaijiang
Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University Institute of Critical Care Medicine in Sino Russian Medical Research Center of Harbin Medical University, Harbin, China.
Medicine (Baltimore). 2017 Jun;96(25):e7090. doi: 10.1097/MD.0000000000007090.
This study aimed to investigate the clinical effectiveness of dexmedetomidine and midazolam for sedation of intensive care unit (ICU) patients requiring flexible fiberoptic bronchoscopy (FFB).This retrospective cohort study included 148 patients from the third ICU ward of the Second Affiliated Hospital of Harbin Medical University (Harbin, China) who received simultaneous invasive mechanical ventilation and FFB between March 2012 and December 2014. Patients were divided into dexmedetomidine (n = 72) and midazolam (n = 76) groups according to sedative mode. The sedative effects, incidence of adverse events, and bronchoscopist satisfaction scores were compared between groups.During FFB, total sedation time and total time of FFB were significantly shorter in the midazolam group (P < .001, respectively), with a lower percentage of these patients requiring propofol for remedial sedation (P < .001). The incidence of FFB-related adverse events (including bronchospasm, cough, and decreased oxygen saturation) was significantly higher in dexmedetomidine group compared with midazolam group (P = .007, .014 and .008, respectively). However, the incidence of other adverse events was not significantly different between groups. In addition, bronchoscopist satisfaction scores were significantly higher in the midazolam compared with dexmedetomidine group (7.72 ± 1.65 vs 7.08 ± 1.77; P = .030).For sedation of ICU patients during FFB, combination of midazolam and dexmedetomidine demonstrated an enhanced sedative effect, lower incidence of adverse events, and higher bronchoscopist satisfaction score compared with dexmedetomidine alone, thus represents a suitable alternative sedative for FFB patients.
本研究旨在探讨右美托咪定和咪达唑仑对需要进行可弯曲纤维支气管镜检查（FFB）的重症监护病房（ICU）患者镇静的临床效果。这项回顾性队列研究纳入了哈尔滨医科大学附属第二医院（中国哈尔滨）第三ICU病房的148例患者，这些患者在2012年3月至2014年12月期间同时接受有创机械通气和FFB。根据镇静方式将患者分为右美托咪定组（n = 72）和咪达唑仑组（n = 76）。比较两组之间的镇静效果、不良事件发生率和支气管镜检查医生的满意度评分。在FFB期间，咪达唑仑组的总镇静时间和FFB总时间显著更短（分别为P <.001），需要丙泊酚进行补救镇静的患者比例更低（P <.001）。与咪达唑仑组相比，右美托咪定组FFB相关不良事件（包括支气管痉挛、咳嗽和血氧饱和度下降）的发生率显著更高（分别为P = .007、.014和.008）。然而，两组之间其他不良事件的发生率没有显著差异。此外，与右美托咪定组相比，咪达唑仑组支气管镜检查医生的满意度评分显著更高（7.72±1.65 vs 7.08±1.77；P = .030）。对于FFB期间ICU患者的镇静，与单独使用右美托咪定相比，咪达唑仑和右美托咪定联合使用显示出增强的镇静效果、更低的不良事件发生率和更高的支气管镜检查医生满意度评分，因此是FFB患者合适的替代镇静剂。
