ICU sedation after coronary artery bypass graft surgery: Dexmedetomidine-based versus propofol-based sedation regimens
ICU sedation after coronary artery bypass graft surgery: Dexmedetomidine-based versus propofol-based sedation regimens
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DOI：
10.1016/s1053-0770(03)00200-3
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发表时间：
2003-10-01
影响因子：
2.8
通讯作者：
England, M
中科院分区：
文献类型：
--
作者：
Herr, DL;Sum-Ping, STJ;England, M
目标：比较重症监护室（ICU）中冠状动脉旁路移植术（CABG）手术后基于右美托咪定和基于丙泊酚的镇静。设计：随机、开放标签。设置：美国和加拿大的25个中心。参与者：295名接受CABG手术的成人。干预措施：在胸骨闭合时，A组患者在20分钟内接受1.0 mug/kg右美托咪定，然后接受0.2至0.7 mug/kg右美托咪定。h维持Ramsay镇静评分在辅助通气期间大于或等于3分，拔管后大于或等于2分。患者可以给予丙泊酚额外的镇静，如果有必要;组B患者接受丙泊酚为基础的护理根据每个调查员的标准practice.Measurements和主要结果：平均镇静水平在两组的目标范围内。平均撤机和拔管时间相似，但右美托咪定患者在8小时后仍使用呼吸机的人数较少。右美托咪定组的吗啡使用显著减少。只有28%的右美托咪定患者在通气时需要吗啡缓解疼痛，而丙泊酚患者为69%（p < 0.001）。丙泊酚患者在ICU时需要4倍于平均剂量的吗啡。两组的平均血压最初均升高，然后右美托咪定患者降至基线以下3 mmHg;丙泊酚患者的平均动脉压保持在基线以上9 mmHg。右美托咪定镇静组患者未发生室性心动过速，而丙泊酚组患者发生率为5%（p = 0.007）。呼吸频率和血气相似。接受β受体阻滞剂治疗的右美托咪定患者较少（p = 0.014），止吐药（p = 0.015），非甾体抗炎药（p < 0.001），肾上腺素（p = 0.030），或高剂量利尿剂（p < 0.001）。右美托咪定为CABG术后患者提供安全有效的镇静，并显著减少镇痛药、β受体阻滞剂、止吐药肾上腺素和利尿剂(C)2003年爱思唯尔公司All rights reserved.
Objective: To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU).Design: Randomized, open label.Setting: Twenty-five centers in the United States and Canada.Participants: Two hundred ninety-five adults undergoing CABG surgery.Interventions: At sternal closure, patients in group A received 1.0 mug/kg of dexmedetomidine over 20 minutes and then 0.2 to 0.7 mug/kg/h to maintain a Ramsay sedation score greater than or equal to3 during assisted ventilation and greater than or equal to2 after extubation. Patients could be given propofol for additional sedation if necessary; group B patients received propofol-based care according to each investigator's standard practice.Measurements and Main Results: Mean sedation levels were within target ranges in both groups. Mean times to weaning and extubation were similar, although fewer dexmedetomidine patients remained on the ventilator beyond 8 hours. Morphine use was significantly reduced in the dexmedetomidine group. Only 28% of the dexmedetomidine patients required morphine for pain relief while ventilated versus 69% of propofol-based patients (p < 0.001). Propofol patients required 4 times the mean dose of morphine while in the ICU. Mean blood pressure increased initially in both groups, then decreased to 3 mmHg below baseline in dexmedetomidine patients; mean arterial pressure remained at 9 mmHg above baseline in propofol patients. No ventricular tachycardia occurred in the dexmedetomidine-sedated patients compared with 5% of the propofol patients (p = 0.007). Respiratory rates and blood gases were similar. Fewer dexmedetomidine patients received beta-blockers (p = 0.014), antiemetics (p = 0.015), nonsteroidal anti-inflammatory drugs (p < 0.001), epinephrine (p = 0.030), or high-dose diuretics (p < 0.001).Conclusion: Dexmedetomidine provided safe and effective sedation for post-CABG surgical patients and significantly reduced the use of analgesics, beta-blockers, antiemetics, epinephrine, and diuretics. (C) 2003 Elsevier Inc. All rights reserved.