Azeem Tamer M Abdel, Yosif Nahed E, Alansary Adel M, Esmat Ibrahim Mamdouh, Mohamed Ahmed K
Intensive care specialist at Intensive Care Department of Dar El Fouad Hospital, Ain-shams University, Cairo, Egypt.
Department of Anesthesia and Intensive Care, Ain-shams University, Cairo, Egypt.
Saudi J Anaesth. 2018 Apr-Jun;12(2):190-197. doi: 10.4103/sja.SJA_303_17.
The aim of this clinical study was to evaluate the efficacy of neurobehavioral, hemodynamics and sedative characteristics of dexmedetomidine compared with morphine and midazolam-based regimen after cardiac surgery at equivalent levels of sedation and analgesia in improving clinically relevant outcomes such as delirium.
Sixty patients were randomly allocated into one of two equal groups: group A = 30 patients received dexmedetomidine infusion (0.4-0.7 μg/kg/h) and Group B = 30 patients received morphine in a dose of 10-50 μg/kg/h as an analgesic with midazolam in a dose of 0.05 mg/kg up to 0.2 mg/kg as a sedative repeated as needed. Titration of the study medication infusions was conducted to maintain light sedation (Richmond agitation-sedation scale) (-2 to +1). Primary outcome was the prevalence of delirium measured daily through confusion assessment method for intensive care.
Group A was associated with shorter length of mechanical ventilation, significant shorter duration of intensive care unit (ICU) stay ( = 0.038), and lower risk of delirium following cardiac surgery compared to Group B. Group A showed statistically significant decrease in heart rate values 4 h after ICU admission ( = 0.015) without significant bradycardia. Group A had lower fentanyl consumption following cardiac surgery compared to Group B.
Dexmedetomidine significantly reduced the length of stay in ICU in adult cardiac surgery with no significant reduction in the incidence of postoperative delirium compared to morphine and midazolam.
本临床研究的目的是在心脏手术后，在等效的镇静和镇痛水平下，评估右美托咪定与吗啡和咪达唑仑方案相比，在神经行为、血流动力学和镇静特性方面对改善诸如谵妄等临床相关结局的疗效。
60例患者被随机分为两个相等的组：A组 = 30例患者接受右美托咪定输注（0.4 - 0.7μg/kg/h），B组 = 30例患者接受剂量为10 - 50μg/kg/h的吗啡作为镇痛药，以及剂量为0.05mg/kg至0.2mg/kg的咪达唑仑作为镇静药，根据需要重复使用。对研究药物输注进行滴定以维持轻度镇静（里士满躁动-镇静量表）（-2至+1）。主要结局是通过重症监护病房谵妄评估方法每日测量的谵妄发生率。
与B组相比，A组机械通气时间更短，重症监护病房（ICU）住院时间显著缩短（P = 0.038），心脏手术后谵妄风险更低。A组在入住ICU 4小时后心率值有统计学意义的下降（P = 0.015），且无明显心动过缓。与B组相比，A组心脏手术后芬太尼消耗量更低。
与吗啡和咪达唑仑相比，右美托咪定显著缩短了成人心脏手术患者在ICU的住院时间，且术后谵妄发生率无显著降低。
