Zhou Wen-Jun, Liu Mei, Fan Xue-Peng
Department of Anesthesiology, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei 430015, P.R. China.
Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China.
Exp Ther Med. 2021 Feb;21(2):156. doi: 10.3892/etm.2020.9297. Epub 2020 Dec 17.
The present study aimed to compare the efficacy and safety of dexmedetomidine and midazolam in patients that are critically ill. Full text articles reporting the clinical effects and complications of dexmedetomidine and midazolam were retrieved from multiple databases. Review Manager 5.0 was adopted for meta-analysis, sensitivity and bias analysis. Finally, a total of 1,379 patients from 8 studies, which met the eligibility criteria, were included. The meta-analysis suggested that the length of stay at the intensive care unit [mean absolute difference (MD)=-1.80; 95% confidence interval (CI), -2.13, -1.48; P<0.00001; P-value for heterogeneity=0.41; I²=3%], time to extubation (MD=-2.18; 95% CI, -2.66, -1.69; P<0.00001; P-value for heterogeneity=0.84; I²=0%) and delirium (MD=0.46; 95% CI, 0.37, 0.57; P<0.00001; P-value for heterogeneity=0.65; I²=0%) was higher following midazolam treatment compared with dexmedetomidine, while bradycardia [odds ratio (OR)=5.03; 95% CI, 3.86, 6.57; P<0.00001; P-value for heterogeneity=0.13; I²=38%] was higher in dexmedetomidine treated patients compared with midazolam. However, no difference was observed in the incidence of hypotension (OR=0.88; 95% CI, 0.70, 1.10; P=0.26; P-value for heterogeneity=0.99; I²=0%) and mortality (OR=0.96; 95% CI, 0.74, 1.25; P=0.77; P-value for heterogeneity=0.99; I²=0%). Taking clinical effects and safety into account, the present study suggested dexmedetomidine to be the preferred option of anesthesia for patients that are critically ill.
本研究旨在比较右美托咪定和咪达唑仑在危重症患者中的疗效和安全性。从多个数据库检索了报告右美托咪定和咪达唑仑临床效果及并发症的全文文章。采用Review Manager 5.0进行荟萃分析、敏感性和偏倚分析。最终，纳入了8项符合纳入标准的研究中的1379例患者。荟萃分析表明，与右美托咪定相比，咪达唑仑治疗后患者在重症监护病房的住院时间[平均绝对差（MD）=-1.8；95%置信区间（CI），-2.13，-1.48；P<0.00001；异质性P值=0.41；I²=3%]、拔管时间（MD=-2.18；95%CI，-2.66，-1.69；P<0.00001；异质性P值=0.84；I²=0%）和谵妄发生率（MD=0.46；95%CI，0.37，0.57；P<0.00001；异质性P值=0.65；I²=0%）更高，而与咪达唑仑相比，右美托咪定治疗患者的心动过缓[比值比（OR）=5.03；95%CI，3.86，6.57；P<0.00001；异质性P值=0.13；I²=38%]更高。然而，低血压发生率（OR=0.88；95%CI，0.70，1.10；P=0.26；异质性P值=0.99；I²=0%）和死亡率（OR=0.96；95%CI，0.74，1.25；P=0.77；异质性P值=0.99；I²=0%）未观察到差异。综合临床效果和安全性考虑，本研究表明右美托咪定是危重症患者麻醉的首选药物。
