| Objective: To observe the effects of dexmedetomidine on sedation and analgesia, and the influence on hemodynamics, respiratory function, inflammation, tissue perfusion and delirium condition in patients with acute aortic dissection.Methods: 30 perioperative patients diagnosed as aortic dissection were selected and randomly divided into the Dexmedetomidine sedation group or midazolam sedation group. All patients were treated in two phases. During the first stage: the loading dose of Dexmedetomidine or midazolam was intravenously pumped within 20 min. At the meantime, all the patients were intravenously injected morphine for analgesia(5mg), diltiazem(15μg/kgï¹'min) and metoprolo(25mg,Q8h) for control of blood pressure and heart rate,respectively. The SBP, RR, SPO2, scores of SAS and NRS were recorded before medication(T0) and after 10 min(T1), 15 min(T2), 20 min(T3).The time of SBP arriving at 120 mm Hg for the two groups were also observed.At the second stage(21 minutes to 24 hours): patients were treated for perioperative target control processing according to aortic dissection guidelines: 1. Patients should be fully analgesed and sedated. The patients intwo groups were continuously pumped Dexmedetomidine at 0.2~0.7μg/kg·h or midazolam at 0.03 ~ 0.125mg/kg.h to maintain sedation, respectively;Morphine was also pumped at 2~4 mg/h for all patients to maintain SAS score for 3~4 points, and resting RNS score for 0~5 points. 2.Antihypertensive treatment: All the patients were intravenously pumped diltiazem at 5~10 μg/kg.min to control SBP to 100~120mm Hg. The change of SBP, RR, HR, SPO2, SAS score and RNS score were also recorded in two groups at T4(after 4 hours), T5(12h), and T6(24h) point. The total consumption of diltiazem and morphine in 24 h, changes of blood lactic acid(lac) and C-reactive protein(CRP), and cardiovascular adverse events in 24 h,the delirium ratio and duration in one week were recorded respectively.Results: During the first stage, SBP, HR, RR, RNS and SAS score at each time point(T1- T3) were declined as compared with T0(P<0.05)except for SPO2;SBP, HR, RNS in Dexmedetomidine group was decerased significantly compared with midazolam group(P<0.05), but RR decreased significantly in midazolam group(P<0.05). At the maintenance phase(T4and T6), there was no significant difference of SBP between two groups(P>0.05), but the hemodynamics in Dexmedetomidine group was more stable than that in midazolam group; HR value and RNS score were lower than that in midazolam group(P< 0.05), while RR decreased significantly in midazolam group(P< 0.05).There were no significant difference for SASscores at T1- Tcf6 point(P>0.05) between the two groups; but the RNS score was lower than that in midazolam group(P<0.05), and the comsumption of morphine and midazolam, the mean time to achieve the target blood pressure, in Dexmedetomidine group was less than that in midazolam group[(68.41±10.50) mg VS(98.72±15.24) mg(P<0.01),(26.09±2.41)min VS(38.51±3.29min(P<0.01)min,(61.81±14.15)mg VS(95.28±13.38)mg(P<0.01), respectively]. Furthermore, the Lac and CRP value was lower than that in group midazolam. The incidence of delirium and duration in Dexmedetomidine group was lower than that in group midazolam(18.24 ±3.87)h VS(49.38±6.25)h, P<0.01).Conclusion: Dexmedetomidine is more suitable for patients with aortic dissection for preoperative sedation and analgesia than midazolam, which will acquire a stable hemodynamics, and also can significantly reduce the use of morphine, diltiazem and metoprolol. Dexmedetomidine can significantly reduce inflammatory stress reaction, improve tissue perfusion,and has little impact on the respiratory function. Compared with the traditional schemes, Dexmedetomidine has high security in sedation and analgesia for treatment of acute Aortic Dissection Patients. |
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