The Influence Of Applying Dexmedetomidineto Patients On The Delirium During Weaning From ICU Mechanical Ventilation

Objective: ICU delirium is a psychiatric disorder that is easily overlooked by clinicians,but it plays an important role in the prognosis and outcome of critically ill patients.However,there is no clear conclusion about the pathophysiology of delirium,prevention and treatment.At present,it is generally believed that we need prompt assessment and management of delirium,especially the assessment and elimination of risk factors.Among them,the sedative strategies and the choice of sedative drugs for ICU patients are very important.It is based on the above theories that we choose dexmedetomidine sedation for patients undergoing weaning from mechanical ventilation,and we need to observe and evaluate its impact on the occurrence of delirium to provide the basis for the sedation of mechanically ventilated patients.Methods: Choose 196 critical ill patients who are evaluated for weaning from mechanical ventilation in Affiliated Hospital of Yan'an University from January 2014 to February 2017,aged at 18-65 years old and evaluated APACHE II score at 10-40.And separated them into 2 groups randomly:intervention group and control group.The intervention group was given dexmedetomidine sedation during off-line training.The control group was treated with midazolam or midazolam and / or propofol.And compared the incidence of delirium between the two groups.During mechanical ventilation,two groups were given midazolam or midazolam and / or propofol sedation.All sedatives were administered according to standard doses.According to the RASS score to assess the depth of sedation,adjust the dose of drugs.Observed indicators: Days of mechanical ventilation;PH,sodium,potassium,creatinine,albumin;patients whether is or not with delirium.Outcomes: 1.In this study,the types of diseases were divided into organic phosphorus poisoning,acute pancreatitis,severe pre-eclampsia and eclampsia,severe pneumonia,septic shock,multiple injuries and other diseases.There were no statistically significant differences in the first few diseases(P values were 0.189,0.552,0.201,0.543,0.458,respectively).There was a statistically significant difference in data analysis for other diseases(P = 0.017 < 0.05).2.Comparison of two groups of patients with general information :age difference was not statistically significant(dexmedetomidine group 39.1214.30 vs.non dexmedetomidine group 41.5813.79,P=0.223>0.05).There was no significant difference in APACHE score between the two groups(dexmedetomidine group 23.756.06 vs.non dexmedetomidine group 23.686.36,P=0.932>0.05).The difference has no statistical significance between the two groups in the number of days of mechanical ventilation [dexmedetomidine group 9 days(6~14)vs.non dexmedetomidine group 9 days(6~15),P=0.205>0.05].3.The use of sedative drugs in the two groups were analyzed,the mechanical ventilation time of the two groups were treated with midazolam or midazolam plus propofol,the difference was not statistically significant(P=0.063 > 0.05).4.Comparison of two groups of patients with biochemical indexes:Hyperkalemia item(P=0.971)and Hypokalemia item(P=0.432);Hypernatremia term(P=0.421)and Hyponatremia items(P=0.431);Creatinine(P=0.441);Hypoproteinemia(P=0.570);Metabolic acidosis(P=0.140)and Metabolic alkalosis(P=0.955).There were no significant differences in all the parameters(P>0.5).5.Comparison of two groups of delirium:dexmedetomidine group delirium in 5 cases,the incidence of delirium in the group accounted for 5.2%;no dexmedetomidine group delirium in 15 cases,the incidence of delirium in the group accounted for 15.2%.The incidence of delirium was compared between the two groups,the difference was statistically significant(P=0.021 < 0.05).Conclusion: Compared with other sedative drugs,dexmedetomidine sedation can reduce the incidence of delirium in ICU mechanical ventilation weaning patients.