Clinical Study Of Dexmedetomidine In Patients With AECOPD Undergoing Mechanical Ventilation

Objective:The effect of Dexmedetomidine on weaning and inflammatory reaction in patients with acute exacerbation of chronic obstructive pulmonary disease?COPD?was observed.Methods:A total of 60 patients with AECOPD receiving mechanical ventilation through tracheal intubation were selected from September2017 to July 2019 in the People's Hospital of Zhangjiajie,affiliated to Hunan Normal University,the patients were randomly divided into the Observation Group?Dexmedetomidine?and the Control Group?Midazolam+Remifentanil?.In the observation group,on the basis of conventional anti-infection,antispasmodic and antiasthmatic treatment,Dexmedetomidine was given to sedation and Analgesia for 10 minutes with a loading dose of 1.0?g/kg,and 0.2-0.7?g/?kg.h?with a sustained dose of 0.2-0.7?g/?kg.h?.The control group was treated with remifentanil combined with Midazolam on the basis of anti-infection,antispasmodic and antiasthmatic treatment.remifentanil was given a loading dose of0.5-1.0?g/kg intravenously,maintained at a rate of 4-9?g/?kg.h?,Midazolam loading dose 0.01-0.05 mg/kg,maintenance dose 0.02-0.1mg/?kg·h?until offline,in both groups,the pump speed was adjusted according to Ramsay score,and the dosage was adjusted according to the patients'conditions.Observe the following indicators:1.Heart rate?HR?and mean arterial pressure?MAP?at 4 hours T4),2 hours?T2?,0 Hours?T0?before withdrawal;2.The relevant parameters of T4,T2 and T0breathing parameters were observed,including breathing frequency?R?,arterial oxygen partial pressure?PaO₂?,arterial carbon dioxide partial pressure?PaCO₂?and finger oxygen?SpO₂?.T4,T2,T0 Ramsay scores were observed.4.The levels of serum IL6?IL-6?and c-reactive protein?CRP?were compared before and after treatment.5.The duration of mechanical ventilation was compared between the two groups.Result:1.General Situation:There was no significant difference in sex composition and age composition between the two groups.2.Hemodynamics at different times:effect on HR:In the observation group,HR at T4?88.40±8.64?was lower than HR at T0?93.97±9.51?;Compared with the control group,HR in the observation group at T4 was significantly lower than that in the control group?96.00±11.90?.The MAP of T4,T2 and T0 had no significant difference between the two groups.3.Indicator of aspiration parameters at different time points:PaO₂ at T4 was significantly lower than that at T2 and T0 in the Observation Group and the Control Group.The results of PaCO₂ showed that PaCO₂ at T0 was higher than PaCO₂ at T2 in the Observation Group and the Control Group.There was no significant difference in R,Sp O₂ of T4,T2,T0 between the two groups.4.Two sets of Ramsay scores:Compared with the control group,the Ramsay score in the observation group at T2 was significantly lower.There was no significant difference between the two groups at T4and T0.5.Serum levels of inflammatory factors:There was no significant difference in IL-6 and CRP between the two groups before treatment.After treatment,IL-6 and CRP of the two groups were decreased,and the observation group was significantly lower than the control group,the difference was statistically significant.6.Two sets of mechanical ventilation time:The mechanical ventilation time in the Observation Group?4.48±0.97?was shorter than that in the control group?5.9±1.06?.Conclusion:1.Dexmedetomidine can reduce the release of inflammatory factors during mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease?COPD?,and play a role in lung protection.2.Dexmedetomidine can shorten the mechanical ventilation time of AECOPD patients with tracheal intubation and mechanical ventilation,which is superior to that of Midazolam combined with remifentanil.