The Effect Of Dexmedetomidine On The Outcome Of Patients With Sepsis

Objective: To evaluate the effect of dexmedetomidine(DEX)on the outcomes,organ function and inflammatory response of patients with sepsis through meta-analysis.Methods: Through searching the English databases Pub Med,Embase,The Cochrane Library and Web of science,we collected prospective controlled trials of all sepsis patients who were treated with dexmedetomidine sedative treatment from the establishment of the database to December2020.The experimental group was treated with dexmedetomidine,and the control group was treated with sedative drugs other than dexmedetomidine,including midazolam,propofol,lorazepam and other sedative drugs.The primary outcome indicator is the mortality of patients with sepsis.Other indicators include the length of stay in ICU,the effect on organ function and inflammation.Rev Man 5.3 software was used for meta-analysis,and when the number of studies was large enough,a funnel chart was used to analyze the risk of article bias.Results: A total of 11 articles were included,10 were randomized controlled trials(RCT),and 1 was a prospective cohort study.Among 1245 patients enrolled,620 cases in the experimental group and 625 cases in the control group were included.Meta-analysis results show that dexmedetomidine can improve the mortality rate of patients(OR=-0.58,95%CI:0.45～0.75,P<0.001),but it cannot shorten the length of ICU hospitalization(MD=-0.08,95%CI:-0.67 ～ 0.52,P=0.80).Organ function,there is no effect on the time of mechanical ventilation(MD=-0.03,95%CI:-1.13～1.06,P=0.95);in terms of renal function,DEX can reduce the patient’s creatinine level((MD=-0.35,95%CI:-0.57～-0.13,P=0.002).At the same time,it can reduce the patient’s cystatin C level(MD=-0.59,95%CI:-0.90～-0.29,P<0.001).But can not reduce the proportion of patients applying continuous renal replacement therapy(CRRT)(OR=1.23,95%CI: 0.70～2.17,P=0.47).The total sepsis-related organ failure score(SOFA score)meta-analysis result is(MD=-0.63,95%CI:-1.3～0.03,P=0.06),and the single kidney score meta-analysis result in the SOFA score is(MD=-0.56,95%CI:-1.00～-0.12,P=0.01).Inflammation: DEX can reduce the level of TNF-αin 24 hours(MD=-3.97,95% CI:-7.72～-0.23,P=0.04),and it can also reduce 24 hours serum IL-1(MD=-0.84,95%CI:-1.54～-0.13,P=0.02),but the 24-hour interleukin 6 level(IL-6)meta-analysis result is(MD=-155.89,95%CI:-350.90～39.12,P=0.12).Conclusions: DEX can improve the mortality of patients with sepsis,but it cannot improve the length of stay in the ICU;DEX can improve the kidney function of patients with sepsis to a certain extent but cannot improve the patient’s the time of mechanical ventilation;DEX can reduce pus Toxic inflammation.