不同镇静剂对机械通气患者预后的影响：一项基于MIMIC-IV数据库的回顾性队列研究
Effect of different sedatives on the prognosis of patients with mechanical ventilation: a retrospective cohort study based on MIMIC-IV database.
作者信息
Shi Xiaoding, Zhang Jiaxing, Sun Yufei, Chen Meijun, Han Fei
机构信息
Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China.
College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China.
出版信息
Front Pharmacol. 2024 Jul 18;15:1301451. doi: 10.3389/fphar.2024.1301451. eCollection 2024.
AIM
To compare the effects of midazolam, propofol, and dexmedetomidine monotherapy and combination therapy on the prognosis of intensive care unit (ICU) patients receiving continuous mechanical ventilation (MV).
METHODS
11,491 participants from the Medical Information Mart for Intensive Care (MIMIC)-IV database 2008-2019 was included in this retrospective cohort study. The primary outcome was defined as incidence of ventilator-associated pneumonia (VAP), in-hospital mortality, and duration of MV. Univariate and multivariate logistic regression analyses were utilized to evaluate the association between sedation and the incidence of VAP. Univariate and multivariate Cox analyses were performed to investigate the correlation between sedative therapy and in-hospital mortality. Additionally, univariate and multivariate linear analyses were conducted to explore the relationship between sedation and duration of MV.
RESULTS
Compared to patients not receiving these medications, propofol alone, dexmedetomidine alone, combination of midazolam and dexmedetomidine, combination of propofol and dexmedetomidine, combination of midazolam, propofol and dexmedetomidine were all association with an increased risk of VAP; dexmedetomidine alone, combination of midazolam and dexmedetomidine, combination of propofol and dexmedetomidine, combination of midazolam, propofol and dexmedetomidine may be protective factor for in-hospital mortality, while propofol alone was risk factor. There was a positive correlation between all types of tranquilizers and the duration of MV. Taking dexmedetomidine alone as the reference, all other drug groups were found to be associated with an increased risk of in-hospital mortality. The administration of propofol alone, in combination with midazolam and dexmedetomidine, in combination with propofol and dexmedetomidine, in combination with midazolam, propofol and dexmedetomidine were associated with an increased risk of VAP compared to the use of dexmedetomidine alone.
CONCLUSION
Dexmedetomidine alone may present as a favorable prognostic option for ICU patients with mechanical ventilation MV.
目的
比较咪达唑仑、丙泊酚和右美托咪定单一疗法及联合疗法对接受持续机械通气（MV）的重症监护病房（ICU）患者预后的影响。
方法
本回顾性队列研究纳入了医学重症监护信息数据库（MIMIC）-IV数据库2008 - 2019年的11491名参与者。主要结局定义为呼吸机相关性肺炎（VAP）的发生率、院内死亡率和MV持续时间。采用单因素和多因素逻辑回归分析评估镇静与VAP发生率之间的关联。进行单因素和多因素Cox分析以研究镇静治疗与院内死亡率之间的相关性。此外，进行单因素和多因素线性分析以探讨镇静与MV持续时间之间的关系。
结果
与未接受这些药物的患者相比，单独使用丙泊酚、单独使用右美托咪定、咪达唑仑与右美托咪定联合、丙泊酚与右美托咪定联合、咪达唑仑、丙泊酚与右美托咪定联合均与VAP风险增加相关；单独使用右美托咪定、咪达唑仑与右美托咪定联合、丙泊酚与右美托咪定联合、咪达唑仑、丙泊酚与右美托咪定联合可能是院内死亡率的保护因素，而单独使用丙泊酚是危险因素。所有类型的镇静剂与MV持续时间呈正相关。以单独使用右美托咪定作为参照，发现所有其他药物组均与院内死亡率风险增加相关。与单独使用右美托咪定相比，单独使用丙泊酚、与咪达唑仑和右美托咪定联合、与丙泊酚和右美托咪定联合、与咪达唑仑、丙泊酚和右美托咪定联合均与VAP风险增加相关。
结论
对于接受机械通气MV的ICU患者，单独使用右美托咪定可能是一个良好的预后选择。
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