瑞马唑仑与咪达唑仑在脓毒症机械通气患者镇静治疗中的效果对比

Remimazolam versus midazolam for sedation in mechanically ventilated patients with sepsis

摘要

目的：探讨瑞马唑仑与咪达唑仑在脓毒症机械通气患者镇静中的有效性、安全性及其对免疫炎症反应的影响。方法：回顾性分析2023年1月至2024年12月武汉大学人民医院重症监护病房（ICU）收治的脓毒症患者86例，瑞马唑仑组44例，咪达唑仑组42例。比较两组在镇静达标率、恢复时间、机械通气时间、ICU住院时间、炎症及免疫指标[中性粒细胞/淋巴细胞比值（NLR）、C反应蛋白（CRP）]、肝功能指标[丙氨酸氨基转移酶（ALT）]，以及谵妄发生率和28天病死率。结果：两组镇静达标率相似（95.5%vs 92.9%，P=0.62）。瑞马唑仑组苏醒更快[（6.5±2.1) h vs （12.4±3.6） h]，P<0.01），机械通气时间[（7.8±3.2） dvs （9.4±3.5） d，P=0.04]和ICU住院时间 [（12.1±4.5) dvs (14.0±5.2) d，P=0.03] 更短。D3时NLR（6.8±2.1vs 8.9±2.8，P=0.02）及CRP水平[（46.5±20.3）mg·L^-1 vs (59.1±25.4)mg·L^-1，P=0.03]在瑞马唑仑组下降更显著。ALT最大值瑞马唑仑组较低（68 U·L^-1 vs 95 U·L^-1，P=0.03）。谵妄发生率瑞马唑仑组较低（18.2% vs 35.7%，P=0.04）。28天病死率两组无统计学差异（36.4% vs 42.9%，P=0.53）。结论：瑞马唑仑在脓毒症机械通气患者中可提供与咪达唑仑相似的镇静效果，但在苏醒速度、炎症控制、肝功能保护、谵妄发生率和ICU住院时间等方面更具优势，提示其可能是此类患者更为适宜的镇静选择。

Abstract

Objective: To investigate the efficacy, safety, and effect on immune-inflammatory response of remimazolam versus midazolam for sedation in mechanically ventilated patients with sepsis. Methods: A retrospective analysis was conducted in 86 septic patients admitted to the ICU of Renmin Hospital of Wuhan University between January 2023 and December 2024, including 44 patients receiving remimazolam and 42 receiving midazolam. Sedation target attainment rate, recovery time, duration of mechanical ventilation, length of ICU stay, inflammatory and immune markers (neutrophil-to-lymphocyte ratio [NLR] and C-reactive protein [CRP]), liver function indicator (alanine aminotransferase [ALT]), delirium incidence, and 28-day mortality were compared between groups. Results: Sedation target attainment rates were similar between groups (95.5%vs 92.9%, P=0.62). Patients in the remimazolam group recovered faster ([6.5±2.1] hvs [12.4±3.6] h,P<0.01), had shorter mechanical ventilation ([7.8±3.2] dvs [9.4±3.5] d,P=0.04) and ICU stays ([12.1±4.5] dvs [14.0±5.2] d,P=0.03). On day 3, NLR ([6.8±2.1]vs [8.9±2.8],P=0.02) and CRP levels ([46.5±20.3] mg·L^-1 vs [59.1±25.4] mg·L^-1, P=0.03) decreased more significantly in the remimazolam group. Peak ALT values were lower in remimazolam group (68 U·L^-1 vs 95 U·L^-1, P=0.03). The incidence of delirium was also lower in the remimazolam group (18.2% vs 35.7%, P=0.04). No significant difference was observed in 28-day mortality (36.4% vs 42.9%, P=0.53). Conclusion: Remimazolam provides comparable sedation efficacy to midazolam in mechanically ventilated septic patients but demonstrates advantages in faster recovery, better control of inflammation, liver protection, lower incidence of delirium, and shorter ICU stays. These findings suggest remimazolam may be a more suitable sedation option in this patient population.

关键词

瑞马唑仑 / 咪达唑仑 / 脓毒症 / 机械通气 / 镇静

Key words

Remimazolam / Midazolam / Sepsis / Mechanical Ventilation / Sedation

参考文献

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基金资助

新发突发与重大传染病防控国家科技重大专项(2025ZD01902600)

湖北省自然科学基金面上项目(2023AFC017)