Clinical Observation Of Remifentanil Combined With Dexmedetomidine For Blood Pressure Control In ICH Patients Undergoing Mechanical Ventilation

Objective: To observe the effect of remifentanil combined with dexmedetomidine on blood pressure control and early intracranial hematoma expansion in ICH patients undergoing mechanical ventilation.Methods: 53 ICH patients with mechanical ventilation were enrolled in the study.These patients were randomly divided into the experimental group(Group D)and the control group(Group M).Systolic blood pressure(110-140 mmHg)was used as the target blood pressure for analgesia and sedation in both groups.Patients in Group D received continuous intravenous infusion of remifentanil(Dosage:3?g/(kg·h))+ dexmedetomidine(Dosage: 0.2-0.6 ?g/(kg·h))for continuous analgesia and sedation;patients in Group M received continuous intravenous infusion of midazolam(Dosage: 0.025-0.10 mg/(kg· h))for sedation;when NVPS score was ? 6,analgesic agent was added for analgesia.Patients in Group D were given remifentanil(0.5 ?g/kg)with a rapid pump injection before the suctioning procedure for procedural pain preconditioning,while patients in Group M were given an equivalent volume of normal saline with a rapid pump injection before the suctioning procedure.The changes of SBP,HR,NVPS score and RASS score were observed before treatment(T0)and at 10 min(T1),30 min(T2),1 h(T3),2 h(T4),6 h(T5),12 h(T6)and 24 h(T7)after treatment.The incidence of early intracranial hematoma expansion,changes in SBP before and after sputum aspiration and the incidence of adverse events were compared between the two groups.Results:Compared with T0,SBP,HR,NVPS score and RASS score of the two groups were decreased(P < 0.05).At T1-T4,the SBP of Group D decreased more rapidly than that of Group M(P < 0.05);at T4-T7,the SBP of both groups were controlled at 110-140 mmHg,and the SBP of Group D was more stable and less fluctuating.After medication(T1–T7),the HR of patients in Group D was significantly lower than that in Group M(P < 0.05).The BP control rate within 1 h of treatment initiation in Group D was higher than that in Group M(62.90% vs.30.77%)(P < 0.05).The time to reach target blood pressure for the first time in Group D was less than that in group M(65.22 ± 30.88)min vs.(82.46 ± 25.51)min(P < 0.05).The magnitude of SBP changes before and after suctioning in Group D was significantly lower than that in Group M(P < 0.05).After treatment(T1-T7),the NVPS score of Group D was lower than that of Group M(P < 0.05),and the RASS score of Group D was higher than that of Group M(P < 0.05).The incidence of early hematoma expansion in the two groups(7.41% vs.19.23%)(P > 0.05).There was no significant difference in the incidence of hypotension and bradycardia between the two groups(P > 0.05).Conclusion:1.Remifentanil combined with dexmedetomidine for blood pressure control in ICH patients with mechanical ventilation,the blood pressure of these patients can be quickly reduced to the target blood pressure,blood pressure is controlled stably,and the protocol has a good analgesic and sedative effect;2.The advantages of remifentanil combined with dexmedetomidine to reduce the incidence of early intracranial hematoma expansion in ICH patients with mechanical ventilation and the safety of this protocol,still need to be confirmed by large-sample,multi-center clinical trials.