Clinical Research Of Sedation With Dexmedetomidine For Surgical Patients Requiring Mechanical Ventilation

Objective: To observe and evaluate the effect of the dose of sedation and analgesic drugs, haemodynamics, Inflammatory response, and delirium in the surgical patients requiring mechanical ventilation in intensive care unit used of dexmedetomidine.Methods:sixty-eight Surgical patients in our hospital (50-99years,Male41,Female27)admitted to the intensive care unit(ICU) in need of sedation and analgesia. They were randomly divided into four groups:①group I (sedation with dexmedetomidine Combined with Propofol, n=17)②group II (sedation with dexmedetomidine Combined with midazolam, n=17)③group III (sedation with propofol, n=17)④group IV (sedation with midazolam, n=17).All patients admitted to the ICU were treated with mechanical ventilation and Sedation and Analgesia with the above sedation drugs combined with fentanyl and intake dose was adjusted to maintain the Ramsay score of2-4. Every half-hour assessment of patients with delirium by CAM-ICU after treatment and Record delirium duration; Record the amount of sedation and analgesia drugs; Blood samples were obtained for analysis levels of TNF-α and IL-6at3interval:pre-administration (TI),6hour after administration (T2),12hour after administration (T3);Record the SBP, DBP and HR at7interval: pre-administration(to),30minutes after administration(ti),1hour after administration (t2),3hour after administration (t3),6hour after administration (t4),9hour after administration (t5) and12hour after administration (t6)Results:l.There was no significant difference in age, gender proportion, weight, acute physiology and chronic health evaluation scoring system II (APACHE II) or Surgery kinds between four groups (P>0.05)2.There was no significant difference in delirium incidence among four groups (P>0.05),the delirium duration in group I and group II was shorter than group III and group IV (P<0.05)3.The dosage of propofol, group I (194.1±51.58) was lower than group III (383.22±69.95)(P<0.05), The dosage of of midazolam,group II (64.05±13.07) was lower than group IV (87.48±18.96)(P<0.05), The dosage of fentanyl, group I and group II was lower than group III and group IV (P<0.05)4.The levels of TNF-α and IL-6at the time points of6hour after administration (T2) and12hour after administration (T3) was higher than pre-administration(TI)in each group. There was no significant difference in the levels of TNF-a and IL-6at the time points of pre-administration(TI)between four groups (P>0.05). The levels of TNF-a and IL-6at the time points of6hour after administration (T2) and12hour after administration (T3) group I and group II was shorter than group III and group IV (P<0.05)5.There was no significant difference in the SBP, DBP and HR at the time points of pre-administration (t0) among four groups (P>0.05).The SBP, DBP and HR at the time points of30minutes after administration (t1),1hour after administration (t2),3hour after administration (t3),6hour after administration (t4),9hour after administration (t5) and12hour after administration (t6) was lower than pre-administration (t0)(P<0.05). The fluctuations of SBP and DBP at the time points of30minutes after administration (t1),1hour after administration (t2),3hour after administration (t3),6hour after administration (t4),9hour after administration (t5) and12hour after administration (t6) group I and group II was smaller than group III and group IV (P<0.05). The fluctuations of HR at the time points of30minutes after administration (t1),1hour after administration (t2),3hour after administration (t3),6hour after administration (t4),9hour after administration (t5) and12hour after administration (t6) group I and group II was greater than group III and group Ⅳ (P<0.05)Conclusion: Sedation by dexmedetomidine Combined with other sedation drugs for Surgical patients requiring mechanical ventilation could reduce the amount of other of sedation and analgesia drugs, delirium duration, Inflammation factors level and Steady blood flow dynamics.