Effect Of Dexmedetomidine On Gastrointestinal Function In Elderly Patients With Severe Pneumonia

Objectives The effects of dexmedetomidine and propofol on gastrointestinal function in elderly patients with severe pneumonia were compared,and some clinical basis were provided for the selection of appropriate sedatives for critically ill patients receiving Enteral nutrition（EN）.Methods One hundred Elderly patients admitted to Intensive Care Unit（ICU）from October 2020 to November 2021 who were clearly diagnosed with severe pneumonia and needed to receive invasive mechanical ventilation were selected and divided into experimental group（n=50）and control group（n=50）.Dexmedetomidine was selected as the sedative in the experimental group,propofol was selected as the sedative for the control group.Compared the general information of the two groups,including gender,age,body mass index（BMI）,nutritional risk screening score（NRS 2002）,acute physiology and chronic health evaluation II（APACHE II）.The clinical indexes related to EN,including the start time of EN,the time of feeding amount up to standard,and the incidence of gastrointestinal symptoms.The nutritional status indexes,including laboratory indexes,such as serum albumin（ALB）,prealbumin（PA）,hemoglobin（Hb）,lymphocyte（LY）,and anthropometric indexes,such as arm muscle circumference（AMC）and triceps skinfold（TSF）.The indices of intestinal mucosal barrier function,including diamine oxidase（DAO）and D-lactate（D-lac）.The general vital signs,including changes in circulatory and respiratory parameters,such as mean arterial pressure（MAP）,heart rate（HR）,oxygenation index（PaO₂/FiO₂）.The clinical prognosis related indicators,including ICU stay,duration of mechanical ventilation and 28d mortality.Results 1 The difference about the general information between the two groups was not significant.2 The comparison results of EN related clinical indicators were as follows:The difference in the start time of EN between the two groups was not significant.The time of feeding amount up to standard in the group sedated with dexmedetomidine was shorter than another group,and the difference was statistically significant.The incidence of abdominal distension,bowel sounds weakened,and reflux aspiration of the group sedated with dexmedetomidine was less than those of another group,and the difference was statistically significant.The difference in the incidence of gastric retention and diarrhea was not significant.3 The comparison results of nutritional status indicators are as follows:The levels of PA,Hb and LY after treatment were higher than those before treatment,and the difference was significant.The levels of ALB,AMC,TSF had no significant difference before and after treatment.There was no significant difference in the levels of ALB,PA,Hb,LY,AMC,TSF between the two groups before treatment.The levels of PA,Hb,LY in the experimental group were higher than those in the group sedated with propofol after treatment,and the difference was statistically significant.The difference in ALB,AMC and TSF between the two groups after treatment was not significant.4 The comparison results of intestinal mucosal barrier function indicators were as follows:The DAO,D-lac were lower after treatment than before treatment in both groups,the difference was statistically significant.There was no significant difference in DAO,D-lac between the two groups before treatment.The DAO and D-lac in the group sedated with dexmedetomidine were lower than those in the control group after treatment,and the difference was statistically significant.5 The comparison results of general vital signs were as follows:The difference in the two groups was statistically significant about the levels of MAP and PaO₂/FiO₂ before and after treatment,the levels after treatment were higher than those before treatment.The HR in the two groups after treatment was lower than that before treatment,and the difference was statistically significant.The results of the comparison in HR,MAP,PaO₂/FiO₂ between the two groups had no significant difference.The difference about HR after treatment was statistically significant,and the HR of the group sedated with dexmedetomidine was lower than that of the group sedated with propofol.The difference in MAP and PaO₂/FiO₂ between the two groups after treatment was not significant.6 The comparison results of clinical prognosis related indicators were as follows:The difference about the duration of mechanical ventilation and ICU stay between the two groups were significant,and the group sedated with dexmedetomidine were shorter than the another group.The difference in the 28d mortality was not significant.Conclusions Sedation with dexmedetomidine in patients with severe pneumonia can improve the patient’s intestinal barrier function,reduce the incidence of gastrointestinal adverse reactions during EN,improve patients’EN tolerance,improve patients’nutritional status,and shorten EN compliance time,ICU stay and duration of mechanical ventilation.Figure 0;Table 14;Reference 117...