Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients - A randomized double blind study
Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients - A randomized double blind study
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DOI：
10.1097/00000542-200409000-00012
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发表时间：
2004-09-01
期刊：
影响因子：
8.8
通讯作者：
Metzler, H
中科院分区：
文献类型：
--
作者：
Dahaba, AA;Grabner, T;Metzler, H
背景：瑞芬太尼的快速起效和作用抵消可以使其快速调整至危重患者所需的镇静水平。作者假设基于瑞芬太尼的治疗方案的疗效优于基于吗啡的治疗方案。 方法：40 名意向治疗患者被随机分配接受盲法输注瑞芬太尼 0.15 mug(.)kg(-1.)min(-1) 或吗啡 0.75 mug(.)kg(-1.)min(-1)。第一个目的是滴定阿片类药物输注，以达到定义为镇静躁动量表 4 的最佳镇静。如果需要额外镇静，则开始咪达唑仑开放标签输注。结果：瑞芬太尼组 (78.3 +/- 6.2) 的平均最佳镇静百分比小时明显长于吗啡组 (66.5 +/- 8.5)。这是通过比吗啡组（0.42 +/- 0.22 变化/小时）更频繁的输注速率调整（0.34 +/- 0.25 变化/小时）实现的。吗啡组的平均机械通气持续时间和拔管时间（18.1 +/- 3.4 小时、73 +/- 7 分钟）分别显着长于瑞芬太尼组（14.1 +/- 2.8 小时、17 +/- 6 分钟）。瑞芬太尼平均输注率为0.13 +/- 0.03 mug(.)kg(-1.)min(-1)，而吗啡平均输注率为0.68 +/- 0.28 mug(.)kg(-1.)min(-1)。吗啡组（20 人中的 9 人）需要咪达唑仑的受试者多于瑞芬太尼组（20 人中的 6 人）。两个治疗组的不良事件发生率较低且具有可比性。结论：基于瑞芬太尼的方案在提供最佳镇痛镇静效果方面比基于标准吗啡的方案更有效。以瑞芬太尼为基础的治疗方案可以使患者更快地从镇静状态中苏醒，并有利于更早拔管。
Background: The rapid onset and offset of action of remifentanil could make it quickly adjustable to the required level of sedation in critically ill patients. The authors hypothesized that the efficacy of a remifentanil-based regimen was greater than that of a morphine-based regimen.Methods: Forty intent-to-treat patients were randomly allocated to receive a blinded infusion of either remifentanil 0.15 mug(.)kg(-1.)min(-1) or morphine 0.75 mug(.)kg(-1.)min(-1). The opioid infusion was titrated, in the first intent, to achieve optimal sedation defined as Sedation Agitation scale of 4. A midazolam open-label infusion was started if additional sedation was required.Results: The mean percentage hours of optimal sedation was significantly longer in the remifentanil group (78.3 +/- 6.2) than in the morphine group (66.5 +/- 8.5). This was achieved with less frequent infusion rate adjustments (0.34 +/- 0.25 changes/h) than in the morphine group (0.42 +/- 0.22 changes/h). The mean duration of mechanical ventilation and extubation time were significantly longer in the morphine group (18.1 +/- 3.4 h, 73 +/- 7 min) than in the remifentanil group (14.1 +/- 2.8 h, 17 +/- 6 min), respectively. Remifentanil mean infusion rate was 0.13 +/- 0.03 mug(.)kg(-1.)min(-1), whereas morphine mean infusion rate was 0.68 +/- 0.28 mug(.)kg(-1.)min(-1). More subjects in the morphine group (9 of 20) than in the remifentanil group (6 of 20) required midazolam. The incidence of adverse events was low and comparable across the two treatment groups.Conclusions: A remifentanil-based regimen was more effective in the provision of optimal analgesia-sedation than a standard morphine-based regimen. The remifentanil-based regimen allowed a more rapid emergence from sedation and facilitated earlier extubation.