■为了比较咪达唑仑的效果,异丙酚,右美托咪定单药和联合治疗对重症监护病房(ICU)持续机械通气(MV)患者预后的影响。
■来自重症监护医疗信息集市(MIMIC)-IV数据库2008-2019的11,491名参与者被纳入这项回顾性队列研究。主要结局定义为呼吸机相关性肺炎(VAP)的发生率,住院死亡率,MV的持续时间。使用单变量和多变量逻辑回归分析来评估镇静与VAP发生率之间的关联。进行单因素和多因素Cox分析以研究镇静治疗与住院死亡率之间的相关性。此外,进行了单因素和多因素线性分析以探讨镇静与MV持续时间之间的关系。
■与未接受这些药物的患者相比,单独使用异丙酚,单用右美托咪定,咪达唑仑和右美托咪定的组合,异丙酚和右美托咪定联合用药,咪达唑仑的组合,丙泊酚和右美托咪定均与VAP风险增加相关;右美托咪定单独,咪达唑仑和右美托咪定的组合,异丙酚和右美托咪定联合用药,咪达唑仑的组合,异丙酚和右美托咪定可能是院内死亡率的保护因素,而单独异丙酚是危险因素。所有类型的镇静剂与MV持续时间之间均呈正相关。以右美托咪定单独作为参考,研究发现,所有其他药物组均与院内死亡风险增加相关.单独使用异丙酚,联合咪达唑仑和右美托咪定,与异丙酚和右美托咪定联合使用,与咪达唑仑合用,与单独使用右美托咪定相比,丙泊酚和右美托咪定与VAP风险增加相关。
■右美托咪定单药可能是ICU机械通气MV患者的有利预后选择。
UNASSIGNED: To compare the effects of midazolam, propofol, and dexmedetomidine monotherapy and combination therapy on the prognosis of intensive care unit (ICU) patients receiving continuous mechanical ventilation (MV).
UNASSIGNED: 11,491 participants from the Medical Information Mart for Intensive Care (MIMIC)-IV database 2008-2019 was included in this retrospective cohort study. The primary outcome was defined as incidence of ventilator-associated pneumonia (VAP), in-hospital mortality, and duration of MV. Univariate and multivariate logistic regression analyses were utilized to evaluate the association between sedation and the incidence of VAP. Univariate and multivariate Cox analyses were performed to investigate the correlation between sedative therapy and in-hospital mortality. Additionally, univariate and multivariate linear analyses were conducted to explore the relationship between sedation and duration of MV.
UNASSIGNED: Compared to patients not receiving these medications, propofol alone, dexmedetomidine alone, combination of midazolam and dexmedetomidine, combination of propofol and dexmedetomidine, combination of midazolam, propofol and dexmedetomidine were all association with an increased risk of VAP; dexmedetomidine alone, combination of midazolam and dexmedetomidine, combination of propofol and dexmedetomidine, combination of midazolam, propofol and dexmedetomidine may be protective factor for in-hospital mortality, while propofol alone was risk factor. There was a positive correlation between all types of tranquilizers and the duration of MV. Taking dexmedetomidine alone as the reference, all other drug groups were found to be associated with an increased risk of in-hospital mortality. The administration of propofol alone, in combination with midazolam and dexmedetomidine, in combination with propofol and dexmedetomidine, in combination with midazolam, propofol and dexmedetomidine were associated with an increased risk of VAP compared to the use of dexmedetomidine alone.
UNASSIGNED: Dexmedetomidine alone may present as a favorable prognostic option for ICU patients with mechanical ventilation MV.