Effect Of Dexmedetomidine On Early Ventilator-associated Pneumonia

Objective To investigate the effects of dexmedetomidine on early ventilator-associated pneumonia effect and possible mechanism.Methods 40 patients with early phase ventilator-associated pneumonia were divided into control group and observation group, 20 cases in each group. The control group was given routine treatment according to the guidelines. The observation group was given to dexmedetomidine,loading dose 0.8¹.0 ?g /kg, push time 10 min, maintenance dose 0.2⁰.7?g /kg·h until 72 hours after diagnosis VAP. Select 3 time points, when the diagnosis of VAP was T1, 72 hours after the diagnosis of VAP was T2, 96 hours after the diagnosis of VAP was T3. Comparison of three time points?1? The breathing mechanics index were compared between the each group, included plateau pressure?Pplat?, peak inspiratory pressure?PIP?, positive end expiratory pressure?PEEP?.?2? The arterial blood gases index were compared between the each group, included PaO₂/FiO₂, arterial CO₂ pressure?PaCO₂?.?3? The plasma inflammatory factor level were compared between the each group, included interleukin-10?IL-10?, procalcitonin?PCT?, interleukin-6?IL-6? and C-reactive protein?CRP?.?4? The clinical pulmonary infection score?CPIS?were compared between the each group.?5? The multiple organ dysfunction syndrome?MODS?rate was compared between the each group.Results?1? At the time point of T1, the Pplat, PIP and PEEP of observation group and control group was not statistically different?P>0.05?. After treatmenttion for T2, the Pplat, PIP and PEEP of observation group significantly lower than control group, there were statistically significant differences between the two groups?P<0.05?. After treatmenttion for T3, the Pplat, PIP and PEEP of observation group significantly lower than control group, there were statistically significant differences between the two groups?P<0.05?.?2?At the time point of T1, the PaO₂/FiO₂, PaCO₂ of observation group and control group was not statistically different?P>0.05?. After treatmenttion for T2, the PaO₂/FiO₂ of observation group significantly higher than control group, there were statistically significant differences between the two groups?P<0.05?. After treatmenttion for T3, the PaO₂/FiO₂ of observation group significantly higher than control group, there were statistically significant differences between the two groups?P<0.05?.But at T2 and T3,the PaCO₂ of observation group and control group was not statistically different?P>0.05?.?3?At the time point of T1, the IL-6,CRP, IL-10 and PCT of observation group and control group was not statistically different?P>0.05?. After treatmenttion for T2, the IL-6,CRP, IL-10 and PCT of observation group significantly lower than control group, there were statistically significant differences between the two groups?P<0.05?. After treatmenttion for T3, the IL-6,CRP, IL-10 and PCT of observation group significantly lower than control group, there were statistically significant differences between the two groups?P<0.05?.?4?At the time point of T1, the CPIS of observation group and control group was not statistically different?P>0.05?. After treatment for T3, the CPIS of observation group significantly lower than control group, there were statistically significant differences between the two groups?P<0.05?.?5?The MODS rate of observation group respectively was 10.0%?2/20?. The MODS rate of observation group respectively was 40.0%?8/20?. The MODS rate of observation group significantly lower than control group?P<0.05?.Conclusion Dexmedetomidine can reduce the levels of inflammatory mediators in early VAP patients, and inhibit the release of pro-inflammatory cytokines and reduce the effect of excessive inflammatory response to organ function, improve the early VAP patients respiratory mechanics and pulmonary oxygen condition, improve the clinical efficacy, reduce the incidence rate of MODS.