Effect Of Dexmedetomidine On The Expression Of HMGB1,D-Lac And I-FABP In Peripheral Blood Of Patients With Sepsis

Objective:To investigate the effect of Dexmedetomidine(DEX)on the intestinal mucosal barrier function in sepsis patients by monitoring the expression level of High mobility group protein B1(HMGB1).Methods:A total of 60 sepsis patients admitted to the Department of Intensive Care Unit of the Affiliated Hospital of Yunnan University from March 2020 to January 2021 were selected as the research objects.All patients in the group met the new sepsis diagnostic criteria established by "Sepsis 3.0"[1].After admission,they were given symptomatic comprehensive treatment in accordance with the guidance of the 2016 International Guidelines for the Management of Sepsis and Septic Shock[2].And refer to the 2018 "Chinese Adult ICU Analgesia and Sedation Treatment Guidelines"[3]for individualized moderate sedation and analgesia treatment.Using random number table method,they were divided into experimental group and control group,with 30 people in each group.Dexmedetomidine diluted with 0.2-0.7 μg/(kg·h)intravenous micropump was used in the experimental group,while midazolam,the ICU sedative essential drug recommended by the guidelines,with 0.03-0.2 mg/(kg·h)intravenous micropump was used in the control group;Patients in both groups were treated with sufentanil analgesia at the same time.Richmond agitation-sedation Scale(RASS)was maintained at-2～0 points.The Critical Care Pain Observation Tool(CPOT)scores ranged from 0 to 1.Compare two groups of patients:(1)General clinical characteristics:age.gender.primary disease and APACHEII and SOFA score;(2)Record the PCT expression levels at each time point of the two groups of patients when they entered the ICU(T0),24h(T1),48h(T2),72h(T3),ELISA was used to determine the levels of HMGB1,D-Lac and I-FABP at each time point in the two groups;(3)Analyze the correlation between inflammatory factors and biological indicators of the intestinal barrier;(4)The total length of stay in ICU of the two groups was recorded,and 28-day survival was followed up by telephone.Using SPSS 22.0 software to perform repeated measures analysis of variance on the data,P<0.05 indicates that the difference is statistically significant.Results:(1)General clinical characteristics:There was no statistically significant difference between the two groups of patients in age,gender,primary disease distribution and APACHEⅡ,SOFA score when entering the ICU(P>0.05);(2)Infection indicators:There was no significant difference in the levels of PCT and HMGB1 between the two groups at T0(P>0.05),but after treatment,the levels of PCT and HMGB1 in the two groups decreased significantly with time(P<0.01),The PCT level of the experimental group was significantly lower than that of the control group at T2 and T3(P<0.01),and the HMGB1 level of the experimental group was significantly lower than that of the control group at T1,T2 and T3(P<0.01);(3)Intestinal barrier function:There was no significant difference in the levels of D-Lac and I-FABP between the two groups at T0(P>0.05),The levels of D-Lac and I-FABP in the experimental group at T1,T2 and T3 were significantly lower than those in the control group at the same time point(P<0.01);(4)Hospitalization and prognosis:The total length of ICU stay in the experimental group was significantly shorter than that in the control group(P<0.05),but there was no significant difference in 28 day mortality between the two groups(P>0.05).Conclusion:(1)Dexmedetomidine can significantly reduce the expression level of biomarkers of intestinal barrier damage in the peripheral blood of patients with sepsis,and reduce the permeability of the intestinal barrier.The mechanism may be related to that dexmedetomidine reduces the expression of HMGB1 in the body and reduces Inflammation is related to the damage of intestinal tissues.(2)Dexmedetomidine can shorten the time of staying in the ICU for patients with sepsis.