The Effect Of Dexmedetomidine On Microcirculation With Septic Shock Patients In ICU

Background:because of its poor prognosis,high mortality rate,long duration,and high cost,septic shock has caused great problems for patients and hospitals.At the present,the treatment of septic shock is still limited to the improvement of the patient's major circulation,and there is still relatively little research on microcirculatory perfusion in patients.Microcirculation as a bridge connecting large circulation with many organs,is involved in the pathophysiology of septic shock.There will also be tremendous changes that will prevent the supply of oxygen to organs.Therefore,patients with septic shock often have multiple organ failure.The single solution to the problem of the patient's major circulation is not enough to fight the damage caused by septic shock.Therefore,microcirculation improvement in septic shock patients should be given more attention.As an indicator that can reflect the patient's microcirculatory perfusion,Vascular falls is still less commonly used in clinical practice.Its physiological significance lies in the fact that after the'heartbeat stops,the important organs that can be drive blood flow in to the heart and brain through the pressure difference in the water fall have been temporarily maintained.Its blood supply.The Pcc(critical closing pressure)is the pressure at which the tiny blood vessels are about to close,that is,when the pressure inside and outside the lumen is equal.Therefore,difference between MAP and Pcc can better reflect the microcirculation perfusion.Septic shock is the main cause of in-patients death because of their heavier infection and more obvious symptoms of shock.Dexmedetomidine is a new type of alpha(2)agonist because it can provide better analgesia,sedative anesthesia and maintain drug dosage with less adverse reactions.In clinical anesthesia.However,it is still unclear whether it is beneficial to patients with septic shock.This article aims to study the effect of dexmedetomidine on microcirculation in patients with septic shock,so as to provide reference for clinical anesthesia choice.Dexmedetomidine(Dex),an alpha(2)agonist,has well-know anesthetic and analgesic-sparing effects.We designed this prospective,randomized,double-blind,and placebo-controlled dose-ranging study to evaluate the effect of Dexmedetomidine on both earlyObjective:To determine the effect of dexmedetomidine when added to standard care in patients with septic shock in the ICUMethods:1.28 septic shock patients in the First Affiliated Hospital Attached to Kunming medical University from May,2016 to July 2017 were prospective studied.2.Patients were admitted to ICU with septic shock and monitored by ECG,and the vital sign were monitored continuously the patients was inserted a centre venous catheter in the right jugular venous for monitoring CVP,a fluid-filled femoral artery catheter in the right femoral artery for monitoring pulse indicator cardiac output(PI CCO),and an artery catheter for monitoring artery blood pressure.3.To make patients get to the standard of EGDT after go in to the intensive care unit for CVP 8-12cmH2O,scvo2>70%,Map>65mmHg.After admit CVP,CO and Map were measured during 7-12 seconds inspiratory hold maneuvers at plateau pressure of 5,15,25,35cmH20.4.Interventions bedside nursing staff administered dexmedetomidine(or placebo)initially at a rate of 0.2 ?g/kg/h and then titrated to rates 0.7 ?g/kg/h to achieve physician-prescribe sedation goals.The study drug or placebo was continued until no longer required or up to 14 days.All other care was at the discretion of the treating physician 5.Collecting date at time of the first day admitted(T1),after day 5(T2)and after day 14(T3).Results:.1.At T3,the date of perfusion of D group was significantly ameliorated compared to C group,Lac inD group was 1.7±0.5mmol/L,in C group was 1.3±0.3mmol/L;Scvo269.1±1.7%,vs.73.2±4.4%;Pv-aco2 4.4±0.6mmHg vs.3.9±0.5mmHg;2.Comapred to C group,the dose of Propofol(5.1±1.4mg/kg/h Vs 6.7±1.3mg/kg/h),Remifentanil(8.3±1.2ug/kg/h Vs 10.5±1.6 ug/kg/h),Noradrenalin to elevate MAP to 65mmHg(0.25±0.10ug/kg/min Vs 0.39±0.13 ug/kg/min)was significantly reduce in D group.3.The vascular waterfall phenomenon in both two group was not important different,but the gap between MAP and Pcc at T3 in D group was different to C group.Conclusion:1.Using Dexmedetomidine intra-operative can ameliorate microcirculation perfusion of patients with septic shock.Dexmedetomidine can improve microcirculation perfusion in patients with septic shock which is concerned with excessive stress reaction.2.The effect of "vascular cascade" in dexmedetomidine patients has not changed obviously,but it can increase the difference between MAP and Pcc,so to improve microcirculation.3.Dexmedetomidine has organ-protective effects and can inhibit apoptotis cell death that plays a pivotal role in the pathogenesis of sepsis.