Effects Of Different Sedation And Analgesia Regimens On Hemodynamics In Patients With Severe Cranial Brain Injury

Objective:Severe craniocerebral injury patients mostly have varying degrees of pain and agitation,the majority of clinical guidelines and practice showed that patients with severe craniocerebral injury require sedation analgesia,sedation analgesia will not only bring severe patients with the same interest and other outside,still can bring more specialized benefits.There is no doubt that is require sedation analgesia in patients with severe craniocerebral injury,but in the clinical work still exist many concerns and dispute,different units in the implementation of sedation analgesia also exist bigger difference,reports of severe craniocerebral injury patients sedation analgesia is less.Based on the above reasons,this study proposed by different groups of craniocerebral injury were treated by different analgesic calm after solution treatment,observation records of hemodynamic parameters between groups,calm analgesic effect and adverse reactions occur,compared two groups of patients with soothing calm and hemodynamic data,thus for sedation analgesia in patients with severe craniocerebral injury related clinical basis.Methodb:Selection of 2016.12-2017.12 months at yanan university affiliated hospital ICU of dongguan branch 60 patients with severe craniocerebral injury,ensure the sedation analgesia scores,the random divided into 2 groups: Dexmedetomidine combined with sufentanil(group A),Dexmedetomidine combined with fentanil(group B).Two groups of patients in addition to the drug intervention factors are different,as far as possiblethe rest factors have no significant difference.Group A:loading dose 0.05 ug/kg sufentanil,0.5 ug/kg dexmedetomidine,maintain:0.1-0.2ug/kg sufentanil,0.3-0.4 ug/kg dexmedetomidine.GroupB:loading dose 0.5ug/kg fentanyl,0.5ug/kg dexmedetomidine:1-2 ugkg fentanyl.,0.3-0.4ug/kg dexmedetomidine.Make pain score<3points,sedation score at 3-4 records.Record the patient before medication(T0),after 4 hours(T1)?8hours(T2)?12 hours(T3)?16 hours(T4)?20 hours(T5)?24 hours(T6)in patients with heart rate,mean arterial pressure of blood oxygen saturation;the time required to observe the Ramsay score of 3~4 was observed.complications occurred during sedation.Result:1.Of the 60 patients who participated in the study,A group 14 were males and 16 were females.B group 17 were males and 13 were females.Patients in different groups of age?weight?sex?APACHE ? and Glasgow coma scale differences were not significant difference(P > 0.05).2.The time of goal sedation between the two groups of patients was found there was significant difference between dexmedetomidine combined with fentanyl group a-nd dexmedetomidine combined with sufentanil group.(30.50±3.74 min vs 28.16± 5.62 min,P =0.008<0.01).The target sedation time in the sufentanil group was shorter than that in the fentanyl group.However,the standard deviation shows that the sufen-tanil group is more stable;the time to reach the target analgesia is reached.,the diffe-rence was not statistically significant.3.Compare different groups during sedation analgesia in patients with complications,group A and group B sinus speed and the occurrence of delirium condition of no statistical significance(P > 0.05),but the two groups of patients during sedation analgesia general complications in group A higher than group B(P =0.045).4.The method of variance analysis with two factors was used by Shapiro-Wilk test,the data of each group is subject to normal distribution.(P < 0.05).ByMauchly's Spherical Hypothesis Test,The variance covariance matrix of the dependent variable is the same.Different sedation,analgesia options and time did not have statistically significant differences in heart rate;there was no statistically significant difference in heart rate between the two sedation and analgesia regimens,F=1.334,P=0.258,so no further comparison was needed.There was no statistically significant effect on the heart rate of patients at each time point,F=0.556,P=0.682,so there was no need to compare.The effects of different sedation,analgesia regimens and time on mean arterial blood pressure were statistically significant,F=5.837,P=0;both methods had different effects on mean arterial pressure,and Sufentanil is 8.642 mmHg lower than the fentanyl group.Since the effect of time on the blood pressure of the patients was statistically significant,the heart rate values in each group were compared one another.It can be seen that the relative mean arterial pressure changes in the sufentanil group are relatively stable.Different time points the effect of pulse oximetry on the patient was not statistically significant,F=1.509,P=0.198,so there was no need to distinguish between patients' pulse oxygen saturation at each time point.The effects of two methods of sedation and analgesia on pulse oxygen saturation were different,and group A was 0.848 higher than group B.Since the effect of time on the oxygenation of patients was statistically significant,comparing the oxygenation values of the two groups within each group,it was found that the changes in oxygenation in the sufentanil group were relatively small.Conclusion:.When sufentanil and fentanyl were combined with dexmedetomidine in patients with severe head injury,there was no statistically significant difference in heart rate between the two groups;the pulse oxygen saturation of fentanyl plus dexmedetomidine was not statistically significant At low,sufentanil plus dexmedetomidine group had lower mean arterial pressure and more stable bloodpressure;both groups could be safely used in patients with severe head injury;both were able to achieve the goal of sedation and analgesia Claim.