| Objective:To investigate and compare the curative effect and safety of use for dexmedetomidine and haloperidol on patients diagonosed with ICU hyperactive type of delirium.Method:Selected 58 patients diagnosed with ICU hyperactive type of delirium based on CAM-ICU assessment method and were hospitalized at The 2nd Affiliated Hospital of Kunming Medical University SICU and EICU within the time range from Apr 2014 to March 2015. The patients are then divided into 2 groups, where group A (n=29) infused with haloperidol and group B (n=29) infused with dexmedetomidine. Group A were given a continuous intravenous infusion with dose of 0.5-2mg of Haloperidol, each intravenous infusion of a loading dose at 2.5mg. Group B were given a continuous intravenous infusion with dose of 0.2-0.7ug/kg.h of dexmedetomidine, each intravenous infusion of a loading dose at lug/kg completed in 20 minutes. Plans were set for both groups to receive sufficient analgesic solution: continuous infusion of sufentani at 0.05-0. 1ug/kg/h, to keep the analgesia score within range of 1-2. The infusion process is strictly inspected, to make sure that the RASS assesment is obtained every 30 minutes, the sedative target for patients was that the RASS score would be -1-0. Addition loading dose will be infused if the continuous infusion proves to be ineffective (RASS score≥+1), if patients’ symptoms are not relieved or getting worse (RASS score≥3) then supplementary plan would be triggered, which is adding loading dose of propofol lmg/kg through intravenous infusion, if patients’ symptoms continues, then infusion of propofol will be combined with continuous intravenous infusion at 0.25-1.5mg/kg.h. Drug withdrawal Plan: Once patients’ symptoms are relieved and and reached the target sedation level, drug will be withdrew and patients will be inspected for 30 minutes, if soon after withdrawl patients quickly show signs of agitation, then the plan outlined above will be readopted, after every 4 hours of infusion, drug will be withdrew for 30 minutes for observation, if patients no longer show signs of agitation and stays below the target sedation level, drug will be withdrew completely.Take record of the curative effectiveness and any adverse effects of the 2 groups, including:the duration time of hyperactive type of delirium;the percentage of additional loading dose used for each group;the percentage of additional infusion of propofol for each group; the total dose used of additional propofol;the percentage of adverse effects showing in each group;the symptoms of the adverse effects;the duration time total delirium after infusion;and the recurrence rate of hyperactive type of delirium.Take record of relevant ending points:the duration time of mechanical ventilation after medicine; the length of stay in ICU after medicine, the total length of stay in ICU;and the 28-day mortality.Results:1. The patients within both groups have no statistical difference (P>0.05) in terms of sex, age, height, weight, BMI, APACHE Ⅱ scores, underlying disease and components of disease.2. For patients diagnosed with mild level of hyperactive type of delirium (RASS score 1-2), using only dexmedetomidine or haloperidol could effectively control symptoms of anxiety and agitation for patients to achieve satisfactory sedation score.The duration time of Group A showing signs of hyperactive type of delirium is comparatively shorter than Group B (Group A 8.17±2.32h vs Group B14.17±5.85h, P=0.027), however Group B is comparatively shorter in the total duration time of delirium after infusion (Group A 28.78±1.56h vs Group B 20.50±1.56h, P=0.001) and the length of stay in ICU after medicine (Group A 98.17±8.71h vs Group B 76.50±19.63h, P=0.001); Group B is as well showing better result in terms of the recurring rate of hyperactive type of delirium (Group A 66.67% vs Group B 15.00%, P=0.001);The percentage of adverse effects is as well significantly lower for group B as compared to Group A(Group A 72% vs Group B 20%, P=0.001).3. For patients with high level of hyperactive type of delirium (RASS rating 3-4), using dexmedetomidine or haloperidol alone will not effectively control the symptoms of agitation, only combined use with continuous intravenous infusion of protofol would help achieve the satisfactory sedation score.The duration time of hyperactive type of delirium has no difference between the two groups (Group A 17.17±1.10h vs Group B 16.25±1.83h, P=0.073); the total dose of propofol used for group B is significantly less than Group A (Group A 764.11±39.71mg vs Group B 724.55±51.36mg, P=0.001); the total duration time of delirium after medication (Group A 30.33±1.53h vs Group B 24.55±1.50h, P=0.001) and the length of stay in ICU after medication (Group A 100.67±12.83h vs Group B 75.65±7.08h, P=0.001) for Group B is less than Group A; the recurring rate of hyperactive type of delirium (Group A 63.67% vs Group B 22.22%, P=0.024) and the percentage of adverse effects (Group A 63.6% vs Group B 33.3%, P=0.043) is as well significantly lower for group B as compared to Group A.4. The total length of stay in ICU, the 28-day mortality and the duration time of mechanical ventilation after medicine shows no statistical difference (P>0.05) for both groups.Conclusion:1. For patients with mild level of ICU hyperactive type of delirium (RASS score 1-2), using either dexmedetomidine or haloperidol alone can effectively control the symptoms and to achieve satisfactory sedation score, at the same time dexmedetomidine shows better curative effect and safety of use than haloperidol.2. For patients with high level of ICU hyperactive type of delirium (RASS score 3-4), combined usage with propofol is necessary to achieve the satisfactory sedation score. |
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