Different Sedatives On The Immune Function Of Stroke Patients With Mechanical Ventilation

Objective:To observe the dynamic changes of peripheral blood IgA,IgG,IgM,complement C3 and complement C4 in stroke patients with mechanical ventilation after using different sedatives,and to analyze and compare the effects of three sedatives on the immune function of stroke patients with mechanical ventilation.Methods:Research object for during July 2018 to February 2019,in the south China university of south China affiliated hospital intensive care of ICU mechanical ventilation stroke after preliminary screening,selection conforms to the standard and rule out this study patients,and the ability to cooperate to complete the experiment of the 45 patients,and under the condition of use of sedatives,research object APACHII score,arterial blood oxygen saturation,heart rate,breathing rate and other vital signs are stable,according to the type of sedative used,they were divided into three groups: Midazolam group,propofol group and dexmedetomidine group.To observe the dynamic changes of serum levels of IgG,IgM,IgA,complement C3 and complement C4 in stroke patients at 1d and 4d after treatment,and the trend of the changes over time.All clinical trial data were analyzed with SPSS22.0 statistical software,and the measurement data were expressed as mean standard deviation.Univariate anova was used for the comparison between groups.LSD method was used forpairwise comparison when the variance was homogeneous,and Tamhane’s T2 test was used for variance inhomogeneity.Results:1.Single sedative T4(4 days after treatment)compared with T1(1days after treatment)in each group:(1)the immune indexes of the patients in the midazolam group on the fourth day of mechanical ventilation were significantly higher than those on the first day(IgG,IgM,and IgA were significantly higher than those on the first day(P <0.05),and the levels of complement C3 and C4 were increased but not significantly(P > 0.05).(2)in the dexmedetomidine and propofol groups,IgG,IgM,IgA,complement C3 and complement C4 were significantly increased on the4 th day of mechanical ventilation compared with the 1st day(P <0.05).2.Comparison between T4 and T1 in different sedative groups:(1)at T1,the IgG index of the dexmedetomidine group was significantly higher than that of the midazolam group and the propofol group(P <0.05),and there was no significant difference among the other four immune indexes(IgM,IgA,complement C3 and complement C4)groups(P > 0.05).(2)at T4,IgG,IgA and IgM values of the dexmedetomidine group were significantly higher than those of the midazolam group and the propofol group(P<0.05),and the differences in complement C3 and complement C4 indexes were not significant(P > 0.05).There was no significant difference between propofol group and midazolam group.(3)the changes of IgG,IgA and IgM in the dexmedetomidine group(t4-t1)were significantly higher than those in the midazolam group and propofol group((P <0.05),while the changes of complement C3 and complement C4 were not significant((P > 0.05).Conclusions:1.In stroke patients with mechanical ventilation,three sedatives,dexmedetomidine,propofol and midazolam,can alleviate the immunosuppressive effect after stroke.2.Among the sedatives used in stroke patients with mechanical ventilation,dexmedetomidine has better immune protection than midazolam and propofol.