| Part oneStudy on the Sedative Mode of Retention of Tracheal Intubation after Repair of Forearm Flap in Oral CancerObjective To investigate the sedative mode and effect of indwelling nasal tracheal duct in ICU after oral forearm flap repair.Method Sixty patients with nasal tracheal ducts who underwent oral forearm flap repair were divided into three groups randomly:midazolam combined with hydromorphone group(group A,n=20),propofol combined with hydromorphone group(group B,N=20),dexmedetomidine combined with hydromorphone group(group C,n=20).After the patients were admitted to the ICU,midazolam in dose of 0.05 mg/kg was injected into the group A for 10 minutes and then keep its injection rate of 0.04?0.2mg/(kg.h)mixed with hydromorphone in rate of 4-8?g/(kg.h);for group B,propofol is injected with dosage of 1.00-3.00 mg/kg in 10 minutes,and then keep injection rate of 0.5?4 mg/(kg.h)combined with hydromorphone in rate of 4-8?g/kg.h-1;for group C,dexmedetomidine is injected in rate of 1?g/kg.h-1 for 10 minutes,and then keep the injection rate of 0.2?0.7?g/(kg.h)mixed with hydromorphone in rate of 4-8pg/(kg.h).Three groups were rated by Ramsay sedation.And the dose of sedative analgesic medications are adjusted in order to make the Ramsay sedation score within 2-4 points.Patients can tolerate tracheal tube and have no cough,irritability,increased blood pressure and heart rate and so on.Record the sedative drug onset time to reach the target sedation range and the time the patients are awake after the drug has been withdrawn.Record the total dosage of the sedative drug for three groups.During indwelling endotracheal intubation,the Ramsay sedation score,VAS score,finger oxygen saturation(SpO2),heart rate(HR),mean arterial blood pressure(MAP),respiratory rate(RR)before using sedative(T0),30min(T1),1h(T2),2h(T3),6h(T4),12h(T5)after injection of sedative and 10min(T6)after extubation,were recorded,and the rate of incidences of adverse reactions,such as decreased respiratory rate,bradycardia and hypotension were calculated.Arterial blood was drawn before extubation to analyze blood gas,and pH,SpO2,and PaCO2 were recorded.Results Midazolam,dextromethorphan and propofol all resulted in a Ramsay score within 2-4,namely,they have similar sedative effect.There was no significant difference in the onset time of sedative drugs among the three groups(p>0.05).The recovery time of dexmedetomidine and propofol was significantly faster than that of midazolam(p<0.05).The total dose of analgesics required in the dexmedetomidine group was less than that in the propofol group and the midazolam group,and the differences were statistically significant(p<0.05).There was no statistically significant difference in the number of bradycardia and hypotension among the three groups(p>0.05).Batroxobin and midazolam may be more likely to cause respiratory depression during sedation compared to dexmedetomidine since the number of patients who needed to be assisted breathing in these two groups was significantly higher than that in the dexmedetomidine group.The number of patients with dexamethasone and propofol was significantly lower than that of midazolam,and the differences were statistically significant(p<0.05).There was no statistically significant difference in mortality among the three groups after sedation treatment.Conclusions In a certain range of dosage,dexmedetomidine and midazolam,propofol can meet the needs for sedation in ICU patients.And dexmedetomidine has analgesic effect,which may save the amount of analgesic drugs to reduce the occurrence of respiratory depression.In addition,compared with midazolam,dexmedetomidine and propofol can reduce the incidence of delirium in ICU patients.There was no difference in mortality among the three groups.Part twoObjective To investigate influences on the stress response and inflammatory cytokines of patients who had indwelling nasal tracheal duct in ICU after oral forearm flap repair.Method Sixty patients underwent oral forearm flap repair with nasal tracheal ducts were divided into three groups randomly in method of random number table:midazolam combined with hydromorphone group(group A,n=20),propofol combined with hydromorphone group(group B,N=20),dexmedetomidine combined with hydromorphone group(group C,n=20).After the patients were admitted to the ICU,midazolam in dose of 0.05 mg/kg was injected into the group A for 10 minutes and then keep its injection rate of 0.04?0.2mg/(kg.h)mixed with hydromorphone in rate of 4-8?g/(kg.h);for group B,propofol is injected with dosage of 1.00-3.00 mg/kg in 10 minutes,and then keep injection rate of 0.5?4 mg/(kg.h)combined with hydromorphone in rate of 4-8?g/kg.h-1;for group C,dexmedetomidine is injected in rate of lpg/kg.h-1 for 10 minutes,and then keep the injection rate of 0.2?0.7?g/(kg.h)mixed with hydromorphone in rate of 4-8?g/(kg.h).The Ramsay sedation score before using sedative(T0),30min(T1),1h(T2),2h(T3),6h(T4),12h(T5)after injection of sedative and 10min(T6)after extubation were recorded.The operation time,blood loss during operation,total amount of liquid input during operation and the indwelling time of tracheal intubation in ICU were recorded;The levels of plasma C reactive protein(CRP),cortisol(Cor),tumor necrosis factor alpha(TNF-a)and interleukin-6(IL-6)before the operation(t0),after the operation(t1)and after end of sedation in ICU(t2)were recorded.Results There was no difference among the three groups in the operation time,blood loss during operation,total amount of liquid input during operation and the indwelling time of tracheal intubation in ICU(p>0.05).The Ramsay score of three groups can lie within 2-4,namely,they have similar sedative effect(p>0.05).The levels of Cor,CRP,TNF-a and IL-6 of the three groups at t1 were significantly increased(p<0.05)compared to those at t0.And the levels of Cor,CRP,TNF-a and IL-6 of the three groups at t2 were significantly decreased(p<0.05)compared to those at t1.Especially,Cor,CRP,TNF-a and IL-6 of group C decreased more obviously compared to those of groups A and B.Conclusions The forearm flap repair of oral cancer can induce stress reaction of body,and then increase the secretion of CRP,Cor and inflammatory cytokines.Under the same sedation depth,dexmedetomidine has the inhibiting effect on secretion of CRP,Cor,TNF-a and IL-6,which is strong than that of propofol and midazolam. |
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