Age effect on efficacy and side effects of two sedation and analgesia protocols on patients going through cardioversion: a randomized clinical trial.
Age effect on efficacy and side effects of two sedation and analgesia protocols on patients going through cardioversion: a randomized clinical trial.
复制标题
年龄对接受心脏复律的患者的两种镇静和镇痛方案的疗效和副作用的影响：一项随机临床试验。
DOI：
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发表时间：
2006
影响因子：
4.4
通讯作者：
E. Saǧiroǧlu
中科院分区：
文献类型：
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作者：
M. Parlak;I. Parlak;Bulent Erdur;A. Ergin;E. Saǧiroǧlu
背景
心脏复律(CV)是一个痛苦的过程，需要镇静和止痛。尽管目前有几种镇静剂用于治疗心血管疾病，但有关咪达唑仑和异丙酚的年龄特异性疗效和副作用的数据有限。
目标
目的：比较咪达唑仑和异丙酚在两个不同年龄组接受心血管检查的患者的疗效和不良反应。
方法
这项临床试验包括70名同意由房颤引起的心血管指征的患者。参与者通过分层随机方法被分为四组：65岁以下的患者接受咪达唑仑(n=12)或异丙酚(n=11)治疗，65岁及以上的患者接受咪达唑仑(n=25)或异丙酚(n=22)治疗。药物是通过缓慢间歇的团注给药的。在CV期间，记录达到Ramsay镇静等级5级的时间(RSS-5；诱导时间)；达到RSS-2的时间(恢复时间)；以及副作用，包括减饱和、呼吸暂停和血流动力学参数的变化，由患者治疗分配盲人记录。
结果
四组患者的平均诱导时间相似。与咪达唑仑组相比，两组异丙酚组的平均恢复时间(min+/-SD)均缩短：65岁以下组分别为18.8(+/-4.06)和40.33(+/-20.8)，65岁或以上组分别为18.2(+/-5.12)和54.2(+/-20.85)(p<；0.001)。与年轻患者相比，每个药物组中年龄较大的参与者需要的药物更少。两组之间的血流动力学没有差异。与年龄匹配的异丙酚组相比，两组咪达唑仑的去饱和度都更高(P<；0.05)。与咪达唑仑组相比，在CV术中焦耳相似的异丙酚组患者的反应更少。
结论
异丙酚恢复时间短，副作用少，镇静效果更舒适，是老年人脑血管痉挛镇静的较好选择。
BACKGROUND
Cardioversion (CV), a painful procedure, requires sedation and analgesia. Although several sedation agents currently are in use for CV, data on age-specific efficacy and side effects of midazolam and propofol have been limited.
OBJECTIVES
To compare the efficacy and side effects of midazolam and propofol in patients of two different age groups, younger than 65 years and 65 years and over, who were going through CV.
METHODS
Seventy consented patients with CV indications caused by atrial fibrillation were included in this clinical trial. The participants were placed into four groups by using a stratified randomization method: patients aged younger than 65 years who were receiving midazolam (n = 12) or propofol (n = 11) and patients 65 years and over who were receiving midazolam (n = 25) or propofol (n = 22). Medications were administered by slow intermittent bolus injections. During CV, time to reach Ramsay Sedation Scale level 5 (RSS-5; induction time); time to reach RSS-2 (recovery time); and side effects including desaturation, apnea, and changes in hemodynamic parameters were recorded by a person blinded to the patient treatment allocation.
RESULTS
Mean induction time was similar in all four groups. Mean recovery time (min +/- SD) was shorter in both propofol groups when compared with both midazolam groups: 18.8 (+/- 4.06) and 40.33 (+/- 20.8) in the group younger than 65 years and 18.2 (+/- 5.12) and 54.2 (+/- 20.85) in the group 65 years or older, respectively (p < 0.001). Older participants in each medication group needed less medication than younger patients. There were no hemodynamic differences between the groups. Desaturation was higher in both midazolam groups as compared with individuals in the age-matched propofol groups (both p < 0.05). Patient reactions were less in propofol groups with similar joules during CV procedures than were those in the midazolam groups.
CONCLUSIONS
Propofol appears to be a better choice for CV sedation in elders because of its short recovery time, fewer side effects, and its more comfortable sedative effect.