比較咪達唑侖、丙泊酚、右美托咪定鎮靜對急性心肌梗死危重患者預后的影響


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貴州醫科大學麻醉與心臟電生理課題組
翻譯：任文鑫 編輯：陳銳 審校：曹瑩
HOLIDAY
背景
關于急性心肌梗死（AMI）危重患者鎮靜治療的研究較少。本研究旨在比較咪達唑侖、丙泊酚和右美托咪定對AMI危重患者預后的影響。
HOLIDAY
方法
我們從重癥監護III醫療信息集市（MIMIC III）數據庫收集臨床數據。427例使用鎮靜劑的AMI患者的數據來自冠心病重癥監護病房（CCU）。從冠心病重癥監護病房(CCU)采集了427名使用鎮靜劑的AMI患者的數據。
HOLIDAY結果
使用咪達唑侖患者有143例，使用丙泊酚患者有272例，使用右美托咪定患者有28例?？傮w患者28天死亡率為23.9%。通過邏輯回歸分析結果表明，與使用丙泊酚或右美托咪定的患者相比，僅使用咪達唑侖的患者與增加28天死亡率顯著相關。在年齡、性別、體重指數（BMI）、白細胞（WBC）、β受體阻滯劑和血運重建的亞組分析中，使用咪達唑侖與增加28天死亡率之間的相關性仍然顯著。通過傾向評分匹配，140名使用咪達唑侖的患者和192名使用非咪達唑侖的患者成功匹配，使用咪達唑侖的患者CCU死亡率、住院死亡率和28天死亡率較高，機械通氣時間和CCU持續時間較長。E值分析表明對未測量的混雜因素具有穩健性。


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HOLIDAY結論
AMI危重患者首選丙泊酚或右美托咪定進行鎮靜治療。
HOLIDAY 原始文獻來源
Xiaowei Jiang,Min Yan.Comparing the impact on the prognosis
of acute myocardial infarction critical patients of using midazolam, propofol, and dexmedetomidine for sedation.Jiang and Yan BMC Cardiovascular Disorders (2021) 21:584.
Comparing the impact on the prognosis of acute myocardial infarction critical patients of using midazolam, propofol, and dexmedetomidine for sedation
Abstract
Background: There are less studies focusing on the sedative therapy of acute myocardial infarction (AMI) critical patients. This study aim to compare the impact on the prognosis of AMI critical patients of using midazolam, propofol and dexmedetomidine.
Methods: We collected clinical data from the Medical Information Mart for Intensive Care III (MIMIC III) database. Data on 427 AMI patients with sedatives using were recruited from in Coronary Heart Disease Intensive Care unit (CCU).
Results: There were 143 patients in midazolam using, 272 in propofol using and 28 in dexmedetomidine using. The rate of 28-days mortality was 23.9% in overall patients. Through logistic regression analysis, only midazolam using was signifcant association with increased 28-days mortality when compared with propofol or dexmedetomidine using. In the subgroup analysis of age, gender, body mass index (BMI), white blood cell (WBC), beta-block, and revascularization, the association between midazolam using and increased 28-days mortality remained signifcantly. Through propensity score matching, 140 patients using midazolam and 192 using non-midazolam were successfullymatched, the midazolam using presented with higher rate of CCU mortality, hospital mortality and 28-days mortality, longer of mechanical ventilation time and CCU duration. E-value analysis suggested robustness to unmeasured confounding.
【 預后|【罌粟摘要】比較咪達唑侖、丙泊酚、右美托咪定鎮靜對急性心肌梗死危重患者預后的影響