【原】【罂粟摘要】七氟醚延长镇静与静脉镇静在危重患者中的比较：一项随机对照试验

七氟醚延长镇静与静脉镇静在危重患者中的比较：一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：杨荣峰   编辑：周倩   审校：曹莹

背景

挥发性麻醉剂更常用于重症监护病房 (ICU) 的镇静作用。然而，长期使用的证据仍然很少。因此，我们进行了一项随机对照试验，比较七氟醚与静脉镇静，特别关注其疗效和安全性。

方法

在这项前瞻性随机对照II b期单中心临床试验中，需要至少 48 小时镇静的 ICU 患者被随机分组接受七氟醚 (S) 或丙泊酚/咪达唑仑 (P)镇静治疗。使用里士满躁动-镇静量表监测镇静质量。镇静终止后，记录自主呼吸和拔管的时间、阿片类药物消耗量、血流动力学、ICU停留时间和住院时间 (LOS) 以及不良事件。

结果 

79 名患者符合随机分组条件。七氟醚组 (n = 39) 和异丙酚组 (n = 40) 的镇静质量相当。然而，使用七氟醚会缩短恢复自主呼吸所需的时间（26 分钟 vs 375 分钟，P < 0.001）。丙泊酚镇静患者的阿片类药物需求量较低（瑞芬太尼：400 μg/h vs 500 μg/h，P = 0.007；舒芬太尼：40 μg/h vs 30 μg/h，P = 0.007），而血流动力学、LOS 及不良事件发生率没有差异。

 结论 

ICU 患者使用七氟醚镇静超过 48 小时可能会更快恢复自主呼吸，而镇静质量与丙泊酚镇静方案相当。七氟醚对于此类患者群体的长期镇静可能被认为是安全的，同时与异丙酚相比并不劣势。

原始文献：Jens, Soukup,Peter, Michel,Annett, Christel et al. Prolonged sedation with sevoflurane in comparison to intravenous sedation in critically ill patients - A randomized controlled trial.[J] .J Crit Care, 2023, 74: 0.

Prolonged sedation with sevoflurane in comparison to intravenous sedation

in critically ill patients – A randomized controlled trial

Background

Volatile anesthetics are used more commonly for sedation in the intensive-care-unit (ICU). However, evidence for long-term use remains low. We therefore conducted a randomized-controlled trial comparing sevoflurane with intravenous sedation with particular focus on efficacy and safety. 

Methods

In this prospective, randomized-controlled phase-IIb monocentric clinical-trial ICU patients requiring at least 48 h of sedation were randomized to receive sevoflurane (S) or propofol/midazolam (P). Sedation quality was monitored using the Richmond-Agitation-Sedation-Scale. Following termination of sedation, the time to spontaneous breathing and extubation, opioid consumption, hemodynamics, ICU and hospital length of stay (LOS) and adverse events were recorded. 

Results 

79 patients were eligible to randomization. Sedation quality was comparable between sevoflurane (n =39) and propofol (n = 40). However, the use of sevoflurane lead to a reduction in time to spontaneous breathing (26 min vs. 375 min, P < 0.001). Patients sedated with propofol had lower opioid requirements (remifentanil:400 μg/h vs. 500 μg/h, P = 0.007; sufentanil:40 μg/h vs. 30 μg/h, P = 0.007) while hemodynamics, LOS or the occurrence of adverse events did not differ. 

Conclusion 

ICU patients sedated with sevoflurane >48 h may return to spontaneous breathing faster, while the quality of sedation is comparable to a propofol-based sedation regime. Sevoflurane might be considered to be safe for long-term sedation in this patient population, while being non-inferior compared to propofol.  

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