Effects of an Early Intensive Blood Pressure-lowering Strategy Using Remifentanil and Dexmedetomidine in Patients with Spontaneous Intracerebral Hemorrhage: A Multicenter, Prospective, Superiority, Randomized Controlled Trial
作者全名：Dong, Rui; Li, Fen; Li, Bin; Chen, Qiming; Huang, Xianjian; Zhang, Jiehua; Huang, Qibing; Zhang, Zeli; Cao, Yunxing; Yang, Mingbiao; Li, Jianwei; Li, Zhanfu; Li, Cuiyu; Liu, Guohua; Zhong, Shu; Feng, Guang; Zhang, Ming; Xiao, Yumei; Lin, Kangyue; Shen, Yunlong; Shao, Huanzhang; Shi, Yuan; Yu, Xiangyou; Li, Xiaopeng; Yao, Lan; Du, Xinyu; Xu, Ying; Kang, Pei; Gao, Guoyi; Ouyang, Bin; Chen, Wenjin; Zeng, Zhenhua; Chen, Pingyan; Chen, Chunbo; Yang, Hong
作者地址：[Dong, Rui; Li, Fen; Yang, Hong] Southern Med Univ, Dept Crit Care Med, Affiliated Hosp 3, 183 West Zhongshan Ave, Guangzhou 510630, Guangdong, Peoples R China; [Li, Bin; Chen, Qiming] Lanzhou Univ, Dept Intens Care Unit, Hosp 1, Lanzhou, Peoples R China; [Huang, Xianjian; Zhang, Jiehua] Shenzhen Univ, Shenzhen Peoples Hosp 2, Affiliated Hosp 1, Shenzhen Key Lab Neurosurg,Dept Neurosurg, Shenzhen, Peoples R China; [Huang, Qibing; Zhang, Zeli] Shandong Univ, Dept Emergency Neurosurg Intens Care Unit, Qilu Hosp, Jinan, Peoples R China; [Huang, Qibing; Zhang, Zeli] Shandong Univ, Brain Sci Res Inst, Jinan, Peoples R China; [Cao, Yunxing] Chongqing Med Univ, Dept Intens Care Unit, Affiliated Hosp 2, Chongqing, Peoples R China; [Yang, Mingbiao] Hunan Univ Med, Neurosurg Dept, Affiliated Hosp 1, Huaihua, Peoples R China; [Li, Jianwei] Zhongshan Peoples Hosp, Dept Crit Care Med, Zhongshan, Peoples R China; [Li, Zhanfu; Li, Cuiyu] Guangdong Sanjiu Brain Hosp, Dept Intens Care Unit, Guangzhou, Peoples R China; [Liu, Guohua; Shen, Yunlong] Southern Med Univ, Dept Neurosurg, Affiliated Hosp 5, Guangzhou, Peoples R China; [Zhong, Shu] Sun Yat Sen Univ, Guangxi Hosp Div, Affiliated Hosp 5, Dept Neurosurg, Nanning, Peoples R China; [Feng, Guang; Zhang, Ming] Zhengzhou Univ, Henan Prov Peoples Hosp, Peoples Hosp, Dept Neurosurg, Zhengzhou, Peoples R China; [Xiao, Yumei; Lin, Kangyue] Maoming Peoples Hosp, Neurol Intens Med Dept, Maoming, Peoples R China; [Shao, Huanzhang; Shi, Yuan] Zhengzhou Univ, Dept Crit Care Med, Henan Prov Peoples Hosp, Peoples Hosp, Zhengzhou, Peoples R China; [Yu, Xiangyou; Li, Xiaopeng] Xinjiang Med Univ, Dept Crit Care Med, Affiliated Hosp 1, Urumqi, Peoples R China; [Yao, Lan; Du, Xinyu] Sun Yat Sen Univ, Dept Emergency Med, Affiliated Hosp 5, Zhuhai, Peoples R China; [Xu, Ying; Kang, Pei] Southern Med Univ, Sch Publ Hlth, Dept Biostat, Guangzhou, Peoples R China; [Gao, Guoyi] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China; [Ouyang, Bin] Sun Yat Sen Univ, Dept Crit Care Med, Affiliated Hosp 1, Guangzhou, Peoples R China; [Chen, Wenjin] Capital Med Univ, Xuanwu Hosp, Dept Neurosurg, Beijing, Peoples R China; [Zeng, Zhenhua] Southern Med Univ, Nanfang Hosp, Dept Crit Care Med, Guangzhou, Peoples R China; [Chen, Pingyan] Southern Med Univ, Sch Publ Hlth, Dept Biostat, Guangzhou, Peoples R China; [Chen, Chunbo] Jinan Univ, Dept Crit Care Med, Clin Med Coll 2, Shenzhen Peoples Hosp, Shenzhen, Peoples R China; [Chen, Chunbo] Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen, Peoples R China; [Yang, Hong] Southern Med Univ, Dept Crit Care Med, Affiliated Hosp 3, 183 West Zhongshan Ave, Guangzhou 510630, Peoples R China
通信作者：Yang, H (通讯作者)，Southern Med Univ, Dept Crit Care Med, Affiliated Hosp 3, 183 West Zhongshan Ave, Guangzhou 510630, Guangdong, Peoples R China.; Yang, H (通讯作者)，Southern Med Univ, Dept Crit Care Med, Affiliated Hosp 3, 183 West Zhongshan Ave, Guangzhou 510630, Peoples R China.
来源：ANESTHESIOLOGY
ESI学科分类：CLINICAL MEDICINE
WOS号：WOS:001248208200014
JCR分区：Q1
影响因子：9.1
年份：2024
卷号：141
期号：1
开始页：100
结束页：115
文献类型：Article
关键词：
摘要：Background:Although it has been established that elevated blood pressure and its variability worsen outcomes in spontaneous intracerebral hemorrhage, antihypertensives use during the acute phase still lacks robust evidence. A blood pressure-lowering regimen using remifentanil and dexmedetomidine might be a reasonable therapeutic option given their analgesic and antisympathetic effects. The objective of this superiority trial was to validate the efficacy and safety of this blood pressure-lowering strategy that uses remifentanil and dexmedetomidine in patients with acute intracerebral hemorrhage. Methods:In this multicenter, prospective, single-blinded, superiority randomized controlled trial, patients with intracerebral hemorrhage and systolic blood pressure (SBP) 150 mmHg or greater were randomly allocated to the intervention group (a preset protocol with a standard guideline management using remifentanil and dexmedetomidine) or the control group (standard guideline-based management) to receive blood pressure-lowering treatment. The primary outcome was the SBP control rate (less than 140 mmHg) at 1h posttreatment initiation. Secondary outcomes included blood pressure variability, neurologic function, and clinical outcomes. Results:A total of 338 patients were allocated to the intervention (n = 167) or control group (n = 171). The SBP control rate at 1h posttreatment initiation in the intervention group was higher than that in controls (101 of 161, 62.7% vs. 66 of 166, 39.8%; difference, 23.2%; 95% CI, 12.4 to 34.1%; P < 0.001). Analysis of secondary outcomes indicated that patients in the intervention group could effectively reduce agitation while achieving lighter sedation, but no improvement in clinical outcomes was observed. Regarding safety, the incidence of bradycardia and respiratory depression was higher in the intervention group. Conclusions:Among intracerebral hemorrhage patients with a SBP 150 mmHg or greater, a preset protocol using a remifentanil and dexmedetomidine-based standard guideline management significantly increased the SBP control rate at 1h posttreatment compared with the standard guideline-based management.
基金机构：China International Medical Foundation [Z2018351902]
基金资助正文：This study was supported by the China International Medical Foundation (to Dr.Yang, grant No. Z2018351902; Beijing, China) and Clinical Research Startup Program of Southern Medical University by the High-level University Construction Funding of Guangdong Provincial Department of Education (to Dr. Yang, grant No. LC2019ZD017; Guangzhou, China).The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
