ICU镇静镇痛药物的年龄相关剂量关系
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Age related inverse dose relation of sedatives and analgesics in the intensive care unit.
背景与目的
重症监护室（ICU）中的镇静和镇痛常基于麻醉方式,而不考虑患者相关因素。ICU麻醉期间镇静剂和镇痛药物的连续输注与推注或短期输注相比，镇静药和镇痛药的药理学特性发生了变化。
方 法
在本前瞻性观察性队列研究中，我们研究了机械通气患者（MV）相关因素与镇静/止痛药剂量之间的关系及其与镇静/镇痛中止的关系。我们纳入机械通气至少24小时的病人，并排除那些难以评估镇静深度的患者。我们收集了72小时内或直到拔管的数据，以先发者优先。使用多变量方差分析，多变量回归和逻辑回归分析数据。
结 果
最终队列（N = 576）主要为男性（64％），平均年龄61.7（15.6）岁，体重63.4（18.2）Kg，急性生理学和慢性健康状况评分Ⅱ为28.2（8），具有30％的住院死亡率。随着年龄的增加，丙泊酚和芬太尼的剂量需求减少，以适应体重（P <0.001）。丙泊酚和芬太尼剂量需求增加的相关的因素是血管加压药的应用（相对平均差（RMD）丙泊酚为1.56（95％置信区间（CI）1.28±1.90）;芬太尼为1.48（1.25±1.76），中心静脉置管（CVL，相对平均差（RMD）异丙酚为1.64（1.15±2.33）;芬太尼为1.41（1.03±1.91））。男性患者丙泊酚剂量（RMD 1.27（1.06±1.49））需求增加。镇静中止不太可能发生在受限制的患者(OR 0.48(CI 0.30±0.78)或那些接受较高镇静/镇痛剂量的患者（OR异丙酚为0.98（CI 0.97±0.99）;芬太尼为0.99（CI 0.98±0.997）），并且与镇静深度无关
结 论
在ICU高龄患者使用较低剂量的镇静/镇痛药物，而中心静脉血管加压素的使用与较高镇静/镇痛药物的使用相关。
原始文献摘要
Amartya Mukhopadhyay,Bee Choo Tai,Deepa Remani,et al.Age related inverse dose relation of sedatives and analgesics in the intensive care unit.Anderson TA.Curr Opin Anaesthesiol.2017 Sep 27.
Purpose：Sedative and analgesic practices in intensive care units(ICUs) are frequently based on anesthesia regimes but do not take account of the important patient related factors.Pharmacologic properties of sedatives and analgesics change when used as continuous infusions in ICU compared to bolus or short-term infusions during anesthesia.
Method：In a prospective observational cohort study,we investigated the association between patient related factors and sedatives/analgesics doses in patients on mechanical ventilation(MV) and their association with cessation of sedation/analgesia.We included patients expected to receive MV for at least 24 hours and excluded those with difficulty in assessing the depth of sedation.We collected data for the first 72 hours or until extubation, whichever occurred first.Multivariate analysis of variance, multivariate regression as well as logistic regression were used.
Result：The final cohort(N = 576) was predominantly male(64%) with mean(SD) age 61.7(15.6) years,weight 63.4(18.2) Kg, Acute Physiology and Chronic Health Evaluation II score 28.2(8) and 30% hospital mortality.Increasing age was associated with reduced propofol and fentanyl doses requirements, adjusted to the weight(p<0.001).Factors associated with higher propofol and fentanyl doses were vasopressor use(Relative mean difference(RMD) propofol 1.56(95% confidence interval(CI) 1.28±1.90); fentanyl 1.48(1.25±1.76) and central venous line placement (CVL,RMD propofol 1.64(1.15±2.33); fentanyl 1.41(1.03±1.91).Male gender was also associated with higher propofol dose(RMD 1.27(1.06±1.49).Sedation cessation was less likely to occur in restrained patients(Odds Ratio,OR 0.48(CI 0.30±0.78)or those receiving higher sedative/analgesic doses(OR propofol 0.98(CI 0.97±0.99);fentanyl 0.99 (CI0.98±0.997),independent of depth of sedation.
conclusion：In conclusion, increasing age is associated with the use of lower doses of sedative/analgesic in ICU,whereas CVL and vasopressor use were associated with higher doses
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