比较分析右美托咪定、咪达唑仑和丙泊酚对 ICU 中癫痫相关死亡率的影响：来自 MIMIC-IV 数据库的见解。

Comparative analysis of dexmedetomidine, midazolam, and propofol impact on epilepsy-related mortality in the ICU: insights from the MIMIC-IV database.

机构信息

Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin, China.

Department of Neurology, Tianjin Huanhu Hospital, No.6 Ji Zhao Road, Jinnan District, Tianjin, 300060, China.

出版信息

BMC Neurol. 2024 Jun 7;24(1):193. doi: 10.1186/s12883-024-03693-1.

DOI:10.1186/s12883-024-03693-1

PMID:38849716

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11157909/

Abstract

BACKGROUND

Dexmedetomidine (Dex), midazolam, and propofol are three distinct sedatives characterized by varying pharmacological properties. Previous literature has indicated the positive impact of each of these sedatives on ICU patients. However, there is a scarcity of clinical evidence comparing the efficacy of Dex, midazolam, and propofol in reducing mortality among people with epilepsy (PWE). This study aimed to assess the impact of Dex, midazolam, and propofol on the survival of PWE.

METHODS

The data were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC)-IV database (version 2.0). PWE were categorized into Dex, midazolam, and propofol groups based on the intravenously administered sedatives. PWE without standard drug therapy were included in the control group. Comparative analyses were performed on the data among the groups.

RESULTS

The Dex group exhibited a significantly lower proportion of in-hospital deaths and a markedly higher in-hospital survival time compared to the midazolam and propofol groups (p < 0.01) after propensity score matching. Kaplan-Meier curves demonstrated a significant improvement in survival rates for the Dex group compared to the control group (p = 0.025). Analysis of Variance (ANOVA) revealed no significant differences in survival rates among the Dex, midazolam, and propofol groups (F = 1.949, p = 0.143). The nomogram indicated that compared to midazolam and propofol groups, Dex was more effective in improving the survival rate of PWE.

CONCLUSION

Dex might improve the survival rate of PWE in the ICU compared to no standard drug intervention. However, Dex did not exhibit superiority in improving survival rates compared to midazolam and propofol.

摘要

背景

右美托咪定（Dex）、咪达唑仑和丙泊酚是三种具有不同药理学特性的镇静剂。之前的文献表明，这些镇静剂中的每一种对 ICU 患者都有积极影响。然而，目前缺乏比较 Dex、咪达唑仑和丙泊酚在降低癫痫患者（PWE）死亡率方面的疗效的临床证据。本研究旨在评估 Dex、咪达唑仑和丙泊酚对 PWE 生存率的影响。

方法

数据从医疗信息共享互助数据库（MIMIC-IV）（版本 2.0）中回顾性提取。根据静脉内给予的镇静剂将 PWE 分为 Dex、咪达唑仑和丙泊酚组。未接受标准药物治疗的 PWE 被纳入对照组。对各组间的数据进行了比较分析。

结果

经过倾向评分匹配后，Dex 组的院内死亡率明显低于咪达唑仑和丙泊酚组，且院内生存时间明显延长（p<0.01）。Kaplan-Meier 曲线显示，Dex 组的生存率明显高于对照组（p=0.025）。方差分析（ANOVA）显示，Dex、咪达唑仑和丙泊酚组的生存率无显著差异（F=1.949，p=0.143）。列线图表明，与咪达唑仑和丙泊酚组相比，Dex 更能有效提高 PWE 的生存率。