Study Of Preventing And Controlling Of Delirium In Ventilated Patients By Simulating The Circadian Clock Sedation In ICU

Objective:According to the characteristics of normal human body biological clock’s circadian rhythm sleep/awake,by dynamic monitoring and control patients sedation depth, simulate normal clock make patients awake during the day and sleep during the night,use this sedation method, to explore the relationship of simulating the circadian clock sedation and the prevalence of delirium and the prognosis of ventilated patients in ICU. Choosing the reasonable and effective sedative method and sedative drug and dosage, reduce the prevalence of delirium and other complications, so as to improve the prognosis of patients.Methods:A total of 84 patients were selected in our research,who were received treatment of invasive ventilation time of 12h or more in our hospital intensive care unit (ICU) between July 2014 and February 2015.14 patients because of the serious adverse reactions or cannot achieve satisfactory sedative effects are eliminated and, eventually,70 patients were enrolled in this study. All of the patients in the conventional application of fentanyl analgesia treatment, patients were randomly divided into simulated circadian clock group (groupA) and the non-simulated circadian clock group (groupB), According to the use of sedative drugs (Dexmedetomidine, propofol, Dexmedetomidine and propofol) is further divided into six groups, namely A1, B1 useing Dexmedetomidine; A2, B2, using propofol, A3, B3 using Dexmedetomidine and propofol; And application of Visual Analogue Scale(VAS) standard, RASS sedation degree evaluation sheet to control the analgesic and to quantify the depth of sedation, titrating the dose of sedative drugs, make the simulated circadian clock set RASS score at 0-1 during the day, at night-1--2; The non-simulated circadian clock group set RASS score at-1--2 day and night;At the same time two groups of patients by ELISA method for monitoring urine 6-hydroxy acid melatonin (aMT6s) levels, summarize the diurnal rhythm;Comparing two groups of patients whether exist differences in the incidence of delirium and other adverse reactions, mechanical ventilation time and extubation time, ICU length of stay, sedative and analgesia drug doses.Results:(l)Gender, age, acute physiology and chronic health rating system II (APACHE II) score based state have no significant difference between the 6 groups (P> 0.05), Each group is comparable.(2)The simulated circadian clock group compared with the non-simulated circadian clock group, through dynamic monitoring aMT6s concentration in the urine, at 6AM the former urine aMT6s level trends to be higher than the latter, but without statistical significance.(3)The simulated circadian clock group compared with the non-simulated circadian clock group, the incidence of delirium rate significantly decreased (P<0.05);A1 compared with Bl, A2 compared with B2, A3 compared with B3, mechanical ventilation time, extubation time, ICU length of stay were shortened (P< 0.05), the use of sedative drugs dose reduced (P< 0.05).(4) Among Sedative drugs contrast, Dexmedetomidine will reduce the incidence of delirium (P< 0.05).(5) The occurrence of delirium is positively correlated with mechanical ventilation time, extubation time, ICU length of stay (P< 0.05).Conclusion:The simulated circadian clock group incidence of delirium and other adverse reactions, mechanical ventilation time and extubation time, ICU length of stay were lower than the non-simulated circadian clock group;The Dexmedetomidine may reduce the incidence of delirium, improve the prognosis of patients.Patients with ICU mechanical ventilation in patients with the occurrence of delirium and mechanical ventilation time, extubation time, ICU length of stay were positively correlated.