| The number of critically ill patients and the scale of intensive care units (ICUs) aregrowing day by day following with the development of intensive care medicine.Most of thepatients in ICU need mechanical ventilation and invasive procedures which inevitably bringpain and anxiety to the patients. So the patient’s sedation and analgesia are universally usedin ICUs. The reasonable sedation can decreased the syndrome of agitation, pain, anxiety, anddelirium, which can reduced the patient’s oxygen consumption and improved the bodycomfort. But the patient’s sedation can decreased the blood pressure, heart rate andrespiratory rate. So how to decreasing the adverse reaction on the drug of sedation, reducingdelirium, and choosing the sedation in ICU was focused by ICU’s doctor.The drug of sedation on the critically ill patients should be choose short half-lifetime andcontrolled drug, and convenient for the doctor to assessed the influence of the patients. Thestudy confirmed the superiority of dexmedetomidine comparing to midazolam in critically illpatients population for short half-lifetime, minimal depression of cardiovascular andpreservation of respiratory drive and double effects in sedation and analgesia. The adverseevents of the cardiovascular system with dexmedetomidine mostly happened followinggiven the load-dose, which may deteriorate hemodynamically in the unstable patients in theICU. To investigate the effects of the different load-dose dexmedetomdine on hemodynamicsof critically ill patient’s at different time points, this study was choose106from January2013to December2014in the First Hospital of Jilin University ICU patient’s to observed thesedative effects and the effects of hemodynamics, when treated with the different drugdelivery of dexmedetomidine, which could guarded for critical therapy in the ICU and thetheory of sedation treatment in the ICU.Objective: The patients were treated with the load-dose dexmedetomdine andno-load-dose dexmedetomidine, we observed the hemodynamics and Sedative effects at thedifferent time points in the critically ICU patient. Sedative effects were assessed on RSS (Ramsay Seclation Score).Methods:106admitted critically ill patients in ICU were randomly divided intoload-dose（n=42）dexmedetomidine group and non-load-dose（n=64）dexmedetomidine group.The monitor was recoded the patient’s SBP,DBP,MAP and HR at the time beforeadministration (T0),10minutes after administration (T10),20minutes after administration (T20),30minutes after administration (T30),45minutes after administration (T45) and60minutes afteradministration (T60); The patient’s sedative effects were assessed with Ramsay SedationScore.Results:1. Patient Characteristics：The non-load-dose group had64patients, female were （30）and male(34), the average age was（58.1±15.12years）; The load-dose group had42patients,female(20) and male (22), the average age was（56.1±18.25years）; The Acute Physiologyand Chronic Health Evaluation Score (APACHEⅡ): The non-load-dose group was27.1±9.4and the load-dose group was29.7±8.5, there was no statistical significance. There was nodifferent on average Body Mass Index (BMI）in the both group. No statistical significance.By the same time, Baseline blood pressure （S/M/D）（non-load-dose group132.1±14.2/80.4±10.7/60.5±8.3; load-dose group135.7±13.6/79.5±12.4/55.39.6mmHg) andthe baseline heart rate（non-load-dose group84.5±10.3/load-dose group85.6±8.9per minute）were no different, and there were no statistical means.2.Sedative Effects(Ramsay Sedation score)：Compared with the T10, the RamsaySedation score in T20was decreased (P<0.05), the group of T30,T45and T60obviouslydecreased (P<0.01) in the group of non-load-dose group. Compared with the T10, the RamsaySedation score in T20,T30,T45and T60have no changes in the group of load-dose group.Compared with the non-load-dose group, we found than the Ramsay Sedation score in the T10and T20obviously decreased (P<0.01) in the group of load-dose group, T30,T45and T60haveno changes.3. Systolic Blood Pressure (SBP): Compared with the T0,the SBP in T10T20, T30,T45andT60have no changes in the group of non-load-dose group. Compared with the T0,the SBP in T10T20,T30decreased (P<0.05), T45and T60have no changes in the group of load-dose group.Compared with the non-load-dose group, we found than the SBP in T10,T20,T30decreased(P<0.05), T45and T60have no changes in the group of load-dose group.4. Diastolic Blood Pressure (DBP): Compared with the T0,the SDP in T10,T20, T30,T45and T60have no changes in the group of non-load-dose. Compared with the T0,the DBP in T20,T30decreased (P<0.05),T10,T45and T60have no changes in the group of load-dose. Comparedwith the non-load-dose group, we found than the DBP in T20and T30decreased (P<0.05)，T10,T45and T60have no changes in the group of load-dose.5. Mean Arterial Pressure (MAP): Compared with the T0,the SDP in T10T20, T30,T45andT60have no changes in the group of non-load-dose. Compared with the T0,the MAP in T10,T20decreased（P<0.05).T30, T45and T60have no changes in the group of load-dose. Comparedwith the no-load-dose group, we found than the MAP in T20decreased (P<0.05).T10,T30,T45and T60have no changes in the group of load-dose.6. Heart Rate (HR): Compared with the T0,the HR in T20and T45decreased（P<0.05),and T30obviously decreased（P<0.01), T10and T60have no changes in the group ofnon-load-dose. Compared with the T0,the HR in T10and T45decreased（P<0.05)，T20and T30obviously decreased（P<0.01), T60have no changes in the group of load-dose. Compared withthe non-load-dose group, we found than the HR inT30and T45decreased（P<0.05), T20obviously decreased（P<0.01), T10and T60have no changes in the group of load-dose.7. Diverse Reaction：There were3cases had cardiac adverse reaction, blood pressuredecreased (2cases), HR decreased (1cases), when we decreased or terminated the dose of drug,the reaction was disappear in the group of load-dose. There were4cases had cardiac adversereaction, blood pressure decreased (2cases), HR decreased (2cases), the delirium (2cases) inthe group of non-load-dose.The two group had no respire inhibition and accidentally extubtion,and adverse reaction had no statistical means.Conclusion：1. Dexmedetomidine could shorted the time of sedation to a satisfy effection. 2. The effection of hemodynamics in the load-dose group were worse stably than thenon-load-dose group, but the study need to observe the large cases, and have a single sedationtreatment. |
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