本文選題：鎮(zhèn)靜 + 咪達(dá)唑侖　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:ICU(Intensive Care Unit)中各種危重患者常出現(xiàn)呼吸功能衰竭,在其救治過程中,有效的機(jī)械通氣在治療措施中尤其重要。但重癥患者在機(jī)械通氣治療中常受各種因素的影響,導(dǎo)致患者出現(xiàn)焦慮、緊張、恐懼、煩躁不安、人機(jī)對抗等不良反應(yīng),從而導(dǎo)致病情加重惡化。因此鎮(zhèn)靜已成為ICU患者機(jī)械通氣的常規(guī)治療。在眾多鎮(zhèn)靜藥物中,丙泊酚和咪達(dá)唑侖是最為常用的鎮(zhèn)靜藥,但單獨使用時均存在一些不良反應(yīng),為了比較傳統(tǒng)ICU鎮(zhèn)靜劑咪達(dá)唑侖和丙泊酚聯(lián)合咪達(dá)唑侖療效及其不良反應(yīng),我們采用系統(tǒng)評價的方法收集、評價、綜合分析全球范圍內(nèi)有關(guān)丙泊酚聯(lián)合咪達(dá)唑侖與咪達(dá)唑侖單用比較的隨機(jī)對照試驗(Randomized Controlled Trial RCT),以期為其臨床應(yīng)用提供證據(jù)。方法:計算機(jī)檢索從建庫開始直至2016年12月的相關(guān)期刊論文(China National Knowledge Infrastructure CNKI)、中國科技期刊數(shù)據(jù)庫、萬方數(shù)據(jù)庫、PubMed、Cochrane Database of Systematic Reviews、Embase。中文檢索詞為:丙泊酚、咪達(dá)唑侖、機(jī)械通氣、重癥護(hù)理單元。英文檢索詞為:propofol、midazolam、mechanical ventilation、intensive care unit。并對被選中文章的參考文章和其他相關(guān)文獻(xiàn)進(jìn)行了二次檢索,盡可能避免遺漏。對納入文獻(xiàn)進(jìn)行資料提取,并評價文獻(xiàn)質(zhì)量,然后按干預(yù)措施不同分為咪達(dá)唑侖聯(lián)合丙泊酚組和咪達(dá)唑侖組。采用Reman5.3軟件進(jìn)行統(tǒng)計,計算出各組數(shù)據(jù)均數(shù)差(Mean Difference MD)、比值比(Odds Ratio OR)、95%可信區(qū)間(Confidence Interval CI),并繪制森林圖。結(jié)果:最終納入15篇隨機(jī)對照研究。共13篇文獻(xiàn)包括908例患者報道了咪達(dá)唑侖聯(lián)合丙泊酚與單用咪達(dá)唑侖對鎮(zhèn)靜起效時間的影響,表明與咪達(dá)唑侖組相比,咪達(dá)唑侖+丙泊酚鎮(zhèn)靜起效更快。共13篇文獻(xiàn)包括1068例患者報道了咪達(dá)唑侖聯(lián)合丙泊酚與單用咪達(dá)唑侖對達(dá)到滿意鎮(zhèn)靜效果時間的比較,表明咪達(dá)唑侖聯(lián)合丙泊酚組達(dá)到滿意鎮(zhèn)靜效果時間更短。共12篇文獻(xiàn)包括868例患者報道了咪達(dá)唑侖聯(lián)合丙泊酚與單用咪達(dá)唑侖對鎮(zhèn)靜后蘇醒時間的比較,表明咪達(dá)唑侖聯(lián)合丙泊酚組鎮(zhèn)靜后患者蘇醒所需時間更短。共11篇文獻(xiàn)包括813例患者報道了咪達(dá)唑侖聯(lián)合丙泊酚組不良反應(yīng)發(fā)生率更低。結(jié)論:咪達(dá)唑侖聯(lián)合丙泊酚應(yīng)用使鎮(zhèn)靜起效迅速、達(dá)到目標(biāo)鎮(zhèn)靜深度所需時間縮短、停用鎮(zhèn)靜藥物后患者恢復(fù)快、不良反應(yīng)發(fā)生率低,明顯改善了咪達(dá)唑侖單獨應(yīng)用的安全性、有效性和經(jīng)濟(jì)性,是ICU患者中一項較好的鎮(zhèn)靜策略。
[Abstract]:Objective Respiratory failure often occurs in critical patients with different types of critical care unit. Effective mechanical ventilation is especially important in the treatment of respiratory failure. However, severe patients are often affected by various factors in mechanical ventilation treatment, leading to anxiety, tension, fear, restlessness, man-machine confrontation and other adverse reactions, which lead to the worsening of the condition. Sedation has become the routine treatment of mechanical ventilation in ICU patients. Among the many sedatives, propofol and midazolam are the most commonly used sedatives, but there are some adverse reactions when they are used alone. In order to compare the efficacy and adverse reactions of traditional ICU sedatives, midazolam and propofol combined with midazolam, In order to provide evidence for clinical application, we collected, evaluated and analyzed the randomized controlled trial (Randomized controlled trial) of propofol combined midazolam and midazolam in the world. Methods: the full text database of China National knowledge Infrastructure (CNKI), China National knowledge Infrastructure (CNKI), Chinese Journal of Science and Technology (CNKI) database, PubMedine Cochrane Database of Systematic Reviews (DBR) and EmbaseBase (EmbaseBase) were searched by computer from the beginning of the database construction until December 2016. Chinese key words: propofol, midazolam, mechanical ventilation, intensive care unit. The key words in English are: propofolia midazolamie mechanical ventilation and intensive care unit. The selected reference articles and other related documents are retrieved twice to avoid omissions as far as possible. The data were extracted and the quality of literature was evaluated. According to the intervention measures, midazolam combined with propofol and midazolam were divided into two groups: midazolam combined with propofol and midazolam. Reman5.3 software was used to calculate the mean difference of data in each group. The ratio was 95% confidence interval and forest map was drawn. Results: 15 randomized controlled trials were included. The effects of midazolam combined with propofol and midazolam alone on the onset time of sedation were reported in a total of 908 patients. The results showed that midazolam propofol was more effective than midazolam group. A total of 13 articles including 1068 patients reported the comparison of midazolam combined with propofol and midazolam alone to achieve satisfactory sedation time, which indicated that midazolam combined with propofol group had a shorter time to achieve satisfactory sedation effect. A total of 12 articles including 868 patients reported the comparison between midazolam combined with propofol and midazolam alone in the recovery time after sedation, indicating that midazolam combined with propofol had a shorter recovery time after sedation. A total of 11 articles including 813 patients reported a lower incidence of adverse reactions in midazolam combined with propofol group. Conclusion: midazolam combined with propofol can improve the safety of midazolam alone. Effectiveness and economy are a good sedative strategy in ICU patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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