| Objective.To observe the effects of dexmedetomidine loading dose of HR、SBP、 DBP、MAP、IL-6 and TNF-a in elderly patients.Method:Selected 60 patients diagnosed with ICU of agitation based on RASS and were hospitalized at the 2nd Affiliated Hospital of Kunming Medical University EICU with in the time range form January 2015 to March 2016.The patients are divided into 2 groups,where group o(n=30) and group Y(n=30).Plans were set for both groups to receive sufficient analgesia score within continuous of sufentani at 0.05-0. lug/kg/h,to keep the analgesia score within range of 1-2. Dex continued 0.2-0.7ug/kg/h,0.4ug/kg/h of the beginning of the dose in both groups.During the Dex period, the RASS score was assessed every 15 minutes.The dose of Dex was adjusted according to the RASS score.Dex dose adjustment 0.1-0.2 ug/kg/h in every time.Sedation target keep the analgesia score within range of -2-O.During the Dex period,1.addition dose wil be infused if the continous infuion proves to be ineffective, if patients’ symptoms are not relieved or getting wore (RASS≥2) then supplementary plan would be triggered,which is adding loading dose of propofol 0.5-lmg/kg trough intravenous infusion in no mechanical ventilation patient;2.If patients, symptoms are not relieved or getting wore (RASS>2) then supplementary plan would be triggered,which is adding loading dose of propofol lmg/kg trough intravenous infusion in mechanical ventilation patient.If the patients, symptoms continous,then infusion of propofol will be combined with continuous intravenous infusion at 0.25-1.5mg/kg/h.2. Drug withdrawal Plan:1.In the process of drug administration, If patients happen Q-T prolongation,hypotension, severe bradycardia, the symptoms were not significantly improved after atropine treatment.Dex is stopped by application. At the same time experimental data are recorded.2.Patient reached thetarget sedation level(RASS-2-0),Dex dose was maintained to patients with tracheal tube in mechanical ventilation patients and Dex was discontinued in patients with non mechanical ventilation.If soon after withdrawl patients quickly show signs of agition,then the plan outlined above will be readopted.After every 4 hours of infusion, drug will be withdrew for observation,if patients no longer show signs of agitation and continue to be in a state of the target sedation level,drug will be withdrew completely;Dex dose was maintained to patients with tracheal tube in mechanical ventilation patients.3.Monitoring indicators of two groups of patients:1.the beganning of application Dex, recording of patients with HB, BP, ECG changes Within 2 hours per 15min, and recording of patients with HB, BP, ECG changes once per 4hours after 2hours.Cessation of Dex record with HB, BP ECG changing of patients, which will be recorded within each 30min once.After 2hours.every 4H will be recorded once.2.The delirium and agitation continued time;3.During Dex, adverse reactions and treatment of clinical pathway; 4.measure of IL-6, TNF-a data, at the beginning of the application of Dex; measure of IL-6, TNF-a data, after stopping the application of Dex.4.Take record of relevant ending points:1 the length of stay in ICU after treatment; 2.28-day mortalityResults:1.0 group and Y group:there was statistical difference (P<0.05)at Age and BMI, the other indicators were not statistically significant (P>0.05).2.Group O and group Y:two groups of patients compared in the duration of agitation,length of stay in ICU, adverse reactions, tachycardia differences were statistically significant (P< 0.05), the other indicators were not statistically significant (P>0.05).3.Statistical results of adverse reactions occurred in the.O group and the Y group: There were 14 patients with adverse reactions in the O group.The incidence of adverse reactions was 46.67%.During Dex,5 patients presented hypotension with in the O group.The incidence of adverse reactions was 16.67%.3 patients were treated with fluid infusion, and the blood pressure was still unable to be corrected in time.9 patients presented bradycardia with in the O group.The incidence of adverse reactions was 30.00%.6patients presented serious bradycardia with in the O group.The incidence of adverse reactions was 20.00%.There were 3 patients with adverse reactions in the Y group.The incidence of adverse reactions was 10.00%.During Dex,2 patients presented hypotension with in the Y group.The incidence of adverse reactions was 6.67%.1 patients were treated with fluid infusion, and the blood pressure was still unable to be corrected in time.2 patients presented bradycardia with in the Y group.The incidence of adverse reactions was 6.67%.1 patients presented serious bradycardia with in the O group.The incidence of adverse reactions was 3.33%.1 patients triggered the supplementary plan in the O group,3patients triggered the supplementary plan in the Y group.4.Comparison between O group and Y group in mechanical ventilation group:The two groups of patients in the length of stay in ICU, Dex dose, bradycardia differences were statistically significant (P< 0.05), and the other indicators were not statistically significant (P> 0.05).5.Comparison between O group and Y group in non mechanical ventilation group: The duration of agitation,Dex dose was statistically significant (P< 0.05) and the other indicators were not statistically significant (P> 0.05).6.0 group HR, SBP, DBP, MAP, were statistically significant differencesrTO, T30, Tlh, T1.5h, T2h, T4h time point HR, SBP, DBP,MAP have statistical significance.T4h, T8h, T12h, T24h time point HR, SBP, DBP, MAP was not statistically significant (P>0.05).There was significant difference in RASS score at different time points (P< 0.001).Patients with HR4h decreased from 85.05+16.47 to 75.43+20.92, a decrease of 11.27%;Patients with4h SBP decreased from 128+16.39 to 118.28+18.12, a decrease of 7.59%;The patient DBP4h was decreased from70.09+9.97 to 65.25+ 10.68,a decrease of 6.90%;The patient MAP 4h was decreased from 88.80+10.59 to 60.62+35.28, a decrease of 31.73%.7.Y group began to give each time point HR, SBP, DBP, MAP no statistical significance.Patients with HR, SBP, DBP, MAP showed a progressive decrease.HR4h from 82.21±12.21 to 79.03+19.91, a decrease of 3.8%; patients with SBP, DBP, MAP4h was not significantly reduced.8.Group O and group Y:two groups of patients with HR, SBP, DBP, MAP Decline range compare, which was statistically significant (P< 0.05).9.0 group and Y group:there are no statistical significance in HR, SBP,,DBP, MAP, but HR, SBP, DBP, MAP showed a gradual rise.10.Compared patients before treatment and after treatment of IL-6 (70.00+ 90.16pg/ml vs 53.26+100.15pg/ml P=0.488), the difference was not statistically significant; TNF-a (0.484+VS 0.399pg/ml 0.315+0.589pg/ml, P=0.058) were compared before and after treatment, the difference was not statistically significant.Conclusion:1.1 Dexmedetomidine can be used for elderly patients with type ICU agitation sedation.2.During the application of dexmedetomidine,There will be appear hypotension and bradycardia in the elderly patients with agitation.The vital signs of the patient should be closely monitored.3.Clinical doses of dexmedetomidine had no significant effect on IL-6 and TNF-a in elderly patients. |
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