Effects Of Different Sedation Regimens On Sedation And Inflammatory Response In Critically Ill Children With Multiple Trauma

Objective: To compare the efficacy and anti-inflammatory effects of dexmedetomidine and midazolam of critical ill children with multiple trauma.Methods: A prospective randomized controlled trial was conducted.Sixty-five critical ill children with multiple trauma admitted to pediatric intensive care unit(PICU)of Anhui Province Children's Hospital from January 2014 to September 2016 were enrolled,who were randomly generated by computer and divided into dexmedetomidine group(33 cases)and midazolam group(32 cases).Children of two groups both received sufentanil for analgesia.Children in dexmedetomidine group firstly received dexmedetomidine with 1.0 ?g/kg intravenous bolus for 10 minutes,then continuous infusion of 0.2-0.7 ?g/kg·h,while in midazolam group children received continuous infusion of midazolam 1-5?g/kg·h.The goal of sedation was to maintain a Richmond agitation-sedation scale(RASS)score of-1 to 0.The level of IL-6,IL-8,IL-10,IL-1?,TNF-? and CRP detected by enzyme-linked immunosorbent assay(ELISA)at 24,48,72 hours after treatment,and the duration of mechanical ventilation,ratio of CRRT,length of stay in the PICU,ratio of sepsis and MOF and mortality were also recorded.Results: Compared with midazolam,dexmedetomidine decreased the level of pro-inflammatory cytokines and increased the level of anti-inflammatory cytokines.At 24 hours after treatment,the levels of serum IL-1?,TNF-? significantly decreased and IL-10 significantly increased.At 48 hours after treatment,the levels of serum IL-6,IL-8,IL-1,TNF-? and CRP significantly decreased and IL-10 significantly increased.At 72 hours after treatment,only the levels of serum IL-8 and CRP significantly decreased.Compared with midazolam,dexmedetomidine could significantly reduce the duration of mechanical ventilation,length of PICU stay,the ratio of sepsis.But there were no significant differences in ratio of CRRT and MOF and mortality between two groups.Conclusions: Compared with midazolam,dexmedetomidine had better efficacy in the treatment of severe multiple trauma in children and reduce the level of inflammation.