右美托咪定与丙泊酚对不同镇静深度危重症患者结局的影响：一项倾向评分加权队列研究。
Effects of dexmedetomidine versus propofol on outcomes in critically ill patients with different sedation depths: a propensity score-weighted cohort study.
机构信息
Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, No. 707, Sec. 3, Zhongyang Rd., Hualien 970, Taiwan; Institute of Medical Sciences, Tzu Chi University, No. 701, Sec. 3, Zhongyang Rd., Hualien 970, Taiwan.
Institute of Medical Sciences, Tzu Chi University, No. 701, Sec. 3, Zhongyang Rd., Hualien 970, Taiwan; Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei 110, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei 110, Taiwan.
出版信息
Anaesth Crit Care Pain Med. 2024 Dec;43(6):101425. doi: 10.1016/j.accpm.2024.101425. Epub 2024 Sep 16.
OBJECTIVE
We explored the effects of dexmedetomidine (DEX) versus propofol on outcomes in critically ill patients and to assess whether these effects are dissimilar under different sedation depths.
METHODS
A stabilized inverse probability of treatment weighting cohort study was conducted using data from the Medical Information Mart for Intensive Care IV database from 2008 to 2019. Adult intensive care unit (ICU) patients who were administered DEX or propofol as the primary sedative were identified. Various statistical methods were used to evaluate the effects of DEX versus propofol on outcomes.
RESULTS
Data on 107 and 2318 patients in DEX and propofol groups, respectively, were analyzed. Compared to the propofol group, the DEX group exhibited longer ventilator-free days on day 28 and a shorter ICU stay. Conversely, it showed null associations of DEX with the risk of 90-day ICU mortality, the odds of persistent organ dysfunction on day 14 and acute kidney injury, and the duration of vasopressor-free days on day 28. Subgroup analyses revealed that DEX positively impacted persistent organ dysfunction on day 14, ventilator-free days on day 28, and ICU stay in the subgroup with a Richmond Agitation Sedation Scale (RASS) score of ≥-2. However, DEX negatively impacted 90-day ICU mortality, persistent organ dysfunction on day 14, and ventilator-free days on day 28 in the subgroup with a RASS score of <-2.
CONCLUSION
Our results indicated that, compared with propofol, DEX had beneficial and adverse impacts on certain ICU outcomes in critically ill patients, and these impacts appeared to depend on sedation depths.
目的
本研究旨在探讨右美托咪定（DEX）与丙泊酚对危重症患者结局的影响，并评估在不同镇静深度下，这些影响是否存在差异。
方法
采用 2008 年至 2019 年医疗信息集市重症监护 IV 数据库中的数据，进行稳定逆概率治疗加权队列研究。纳入使用 DEX 或丙泊酚作为主要镇静剂的成年重症监护病房（ICU）患者。采用多种统计方法评估 DEX 与丙泊酚对结局的影响。
结果
分析了 DEX 组和丙泊酚组中分别有 107 例和 2318 例患者的数据。与丙泊酚组相比，DEX 组在第 28 天的无呼吸机天数更长，ICU 入住时间更短。相反，DEX 与 90 天 ICU 死亡率、第 14 天持续器官功能障碍的风险、急性肾损伤以及第 28 天无血管加压素天数的持续时间均无关联。亚组分析显示，DEX 对 RASS 评分≥-2 的亚组中第 14 天持续器官功能障碍、第 28 天无呼吸机天数和 ICU 入住时间具有积极影响，但对 RASS 评分<-2 的亚组中 90 天 ICU 死亡率、第 14 天持续器官功能障碍和第 28 天无呼吸机天数具有负面影响。
结论
与丙泊酚相比，DEX 对危重症患者的某些 ICU 结局有有益和不利的影响，这些影响似乎取决于镇静深度。
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