导读： 右美托咪定在危重患者镇静中的早期应用:许多危重患者或术后留置气管导管的患者需要使用镇静剂来降低呼吸机阻力或增加对气管导管的抵抗程度。一种理想的镇静剂应该是能够在不影响患者血流动力学稳定和呼吸抑制的情况下维持镇静，并能快速清醒而不蓄积。 右美托咪定作为镇静剂

rass镇静评分表,rass镇静评分表最佳镇静目标

危重病患者早期应用右美托咪啶镇静

导读:

很多危重症患者或术后保留气管导管的患者需要使用镇静剂以减少呼吸机对抗或增加耐管程度，理想的镇静剂应该能维持镇静的同时，不影响患者的血液动力学稳定和抑制呼吸，唤醒迅速而又无蓄积作用。右美托嘧啶作为镇静剂使用临床效果如何呢？下面这篇发表在《N Eng J Med》的文献《Early Sedation With Dexmedetomidine in Critically Ill Patients》通过随机试验的方法比较右美托嘧啶作为唯一镇静剂和其他镇静剂的临床效果，会得出什么样的结论呢？我们一起看一下摘要吧！详细内容可下载原始文献深入了解。

中文译文

背景：右美托咪啶在维持一定程度唤醒的同时产生镇静作用，并可能减少重症监护病房(ICU)患者的机械通气和精神错乱的持续时间。右美托咪啶作为唯一或主要镇静剂在机械通气患者中的应用尚未得到广泛研究。

方法：在一项开放的随机试验中，我们招募了在ICU接受机械通气至少12小时的危重成年患者，他们预计持续接受机械通气支持到第二天，接受右美托咪啶作为唯一或主要镇静剂或接受常规护治疗理(异丙酚、咪达唑仑或其他镇静剂)。镇静程度评估表（RASS镇静评分）的镇静评分目标范围是-2到+1(轻度镇静到躁动)， RASS镇静评分的得分范围从-5[无反应]到+4[好斗]。主要结果是90天内各种原因的死亡率。

结果：我们招募了4000名患者，在合格和随机之间的中位数间隔为4.6小时。在一项涉及3904名患者的改良意向治疗分析中，右旋美托咪啶组1948年的566例(29.1%)和普通医疗组的1956年的569例(29.1%)发生了主要结果事件(调整后的危险差为0.0%；95%的置信区间为-2.9至2.8)。一个辅助发现是，为了达到规定的镇静水平，右美托咪啶组的患者在随机分组后的前2天接受了补充镇静剂异丙酚(64%的患者)、咪达唑仑(3%)或两者兼用(7%)；在常规治疗组中，分别有60%、12%和20%的患者使用这些药物作为主要镇静剂。心动过缓和低血压在右美托咪啶组更为常见。

结论：在ICU接受机械通气的患者中，早期接受右美托咪啶镇静的患者在90天的死亡率与常规治疗组相似，需要补充镇静剂才能达到规定的镇静水平。右美托咪啶组报告的不良事件比常规治疗组更多。(由澳大利亚国家健康和医学研究委员会等资助；SPICE III ClinicalTrials.gov编号：NCT01728558。)

原文摘要

Early Sedation With Dexmedetomidine in Critically Ill Patients

Background: Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilation has not been extensively studied.

Methods: In an open-label, randomized trial, we enrolled critically ill adults who had been undergoing ventilation for less than 12 hours in the ICU and were expected to continue to receive ventilatory support for longer than the next calendar day to receive dexmedetomidine as the sole or primary sedative or to receive usual care (propofol, midazolam, or other sedatives). The target range of sedation-scores on the Richmond Agitation and Sedation Scale (which is scored from -5 [unresponsive] to +4 [combative]) was -2 to +1 (lightly sedated to restless). The primary outcome was the rate of death from any cause at 90 days.

Results: We enrolled 4000 patients at a median interval of 4.6 hours between eligibility and randomization. In a modified intention-to-treat analysis involving 3904 patients, the primary outcome event occurred in 566 of 1948 (29.1%) in the dexmedetomidine group and in 569 of 1956 (29.1%) in the usual-care group (adjusted risk difference, 0.0 percentage points; 95% confidence interval, -2.9 to 2.8). An ancillary finding was that to achieve the prescribed level of sedation, patients in the dexmedetomidine group received supplemental propofol (64% of patients), midazolam (3%), or both (7%) during the first 2 days after randomization; in the usual-care group, these drugs were administered as primary sedatives in 60%, 12%, and 20% of the patients, respectively. Bradycardia and hypotension were more common in the dexmedetomidine group.

Conclusions: Among patients undergoing mechanical ventilation in the ICU, those who received early dexmedetomidine for sedation had a rate of death at 90 days similar to that in the usual-care group and required supplemental sedatives to achieve the prescribed level of sedation. More adverse events were reported in the dexmedetomidine group than in the usual-care group. (Funded by the National Health and Medical Research Council of Australia and others; SPICE III ClinicalTrials.gov number, NCT01728558.).

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