The Efficacy Of Dexmedetomidine In Patients With Sepsis-associated Encephalopathy

OBJECTIVE:To observe the efficacy of the early goal-directed light sedation based on dexmedetomidine in patients with sepsis-associated encephalopathy?SAE?and to explore its underlying mechanisms.METHODS:A total of 60 adult patients with SAE who were treated in the Intensive Care Unit of the First Affiliated Hospital of University of South China from April to December of 2017 were divided into dexmedetomidine sedation group?abbreviated:group D,n=30?and propofol sedation?abbreviated:group P,n=30?by random number method.Then the patients in group D was treated with dose of 0.2-0.7?g/?kg·h?dexmedetomidine,however,the patients in group P was given a loading dose of 1-3 mg/kg propofol and then maintenance dose was 0.5-4mg/?kg·h?to keep sedation.The two groups of sedative treatment lasted more than 72 hours.The patients' sedative goal was RASS score of-2 to+1.When the RASS score was more than 2 points,Group D was injected with propofol to achieve the sedative goal.When the RASS score was?-3,reduced the dosage of dexmedetomidine or propofol to achieve the sedative goal.The gender,age,height and weight,diagnosis of each group were recorded.Before each group of patients received sedative treatment?T₀?,APACHEII scores and SOFA scores were performed.Peripheral blood was collected and detected levels of IL-6,CRP,S-100?protein and NSE.After two group received sedation at the first?T₁?,3?T₃?,and 7?T₇?days,collected CAM-ICU scores?SOFA scores,and serum IL-6,CRP,S-100?and NSE.The duration of delirium within 7days and the amount of remifentanil,the prognosis of 28 days in two group were recorded.RESULTS:1.Levels of serum IL-6?CRP in both groups were significantly lower at T₁,T₃,and T₇?P<0.05?.At T₃ and T₇,levels of serum IL-6?CRP in group D were significantly lower than those in group P?P<0.05?.2.The scores of SOFA in the two groups were significantly decreased at T₃ and T₇?P<0.05?.At T₃ and T₇,the score of the D group was significantly lower than that in the group P?P<0.05?.3.Levels of serum S100?in both groups decreased significantly at T₃ and T₇?P<0.05?.At T₃,levels of serum S100?in group D were significantly lower than those in group P?P<0.05?.4.Levels of serum NSE in both groups decreased significantly at T₇?P<0.05?.At T₇,levels of serum NSE in group D were significantly lower than those in group P?P<0.05?.5.There was no significant difference in the CAM-ICU scores between the two groups at T₁,T₃,and T₇?P>0.05?.The duration of delirium in group D?3.71±0.76?days and that in group P?5.00±1.29?days,there was significantly lower in group D than in group P?P<0.05?.6.The 28-day mortality rate in the two groups was compared with 4deaths in group D?13.33%?and 6 deaths in group P?20.00%?,there was no statistically significant difference in mortality between the two groups?P>0.05?.CONCLUSIONS:The early goal-directed light sedation based on dexmedetomidine can reduce systemic inflammatory response of patients with SAE,reduce brain damage in patients,but can not reduce the 28-day mortality.