| Part ⅠStudy on the prognosis of dexmedetomidine in patients with septic shock in Intensive Care Unit(ICU)Objective:To investigate the association of dexmedetomidine(DEX)only sedation and hemodynamics,prognosis in patients with septic shock in ICU.Methods:This study was a retrospective study based on the intensive care database.Septic shock patients with mechanical ventilation were included.The primary endpoint was the ratio of norepinephrine equivalent dose to mean arterial pressure(NEq/MAP)between DEX and Non-DEX group.The secondary endpoints were the effect of DEX on hemodynamic parameters,biochemical indicators and mortality.Univariate,propensity score matching(PSM),and generalized linear mixed model(GLMM)analyses were performed.Results:After adjusting for confounding factors in GLMM analysis,DEX was associated with the decrease of NEq/MAP ratio in the first 72 hours(difference = 0.05,95%CI=-0.02-0.08,p=0.002).DEX was associated with the decrease of heart rate,cardiac output,lactate,aspartate transaminase(AST)and the increase of PaO2/FiO2(p<0.017).DEX only sedation was associated with a reduction in 90-day mortality(OR=0.60,95%CI=0.37-0.945,p=0.030).Conclusion:DEX may be associated with decreased vasopressor requirements and 90-day mortality in patients with septic shock.Part ⅡStudy on the efficacy and safety of commonly used sedation regimens for patients after oral and maxillofacial surgery in ICUObjective:To explore the efficacy and safety of commonly used sedation regimens in ICU for patients with mechanical ventilation after oral and maxillofacial surgery.Methods:This study was a retrospective observational study.Patients with mechanical ventilation after oral and maxillofacial surgery in ICU were included.Patients were divided into propofol(P)group,propofol+midazolam(PM)group and propofol+dexmedetomidine(PD)group.The differences among the groups were compared by one-way ANOVA,Kruskal-Wallis test,Chi-square test or Fisher’s exact test.Univariate and multivariate binary logistic regression analysis was used to analyze risk factors of delirium.Results:The incidence of delirium in this study was 16.67%.Compared with P or PD group,patients in PM group had higher incidence of delirium(p=0.018),higher sedation success rate(p=0.016),and longer length of stay in ICU(p=0.000).Combined use of midazolam is the strongest predictor of delirium,which can increase the risk of delirium by 3.218 times(95%CI=1.041-9.950,p=0.042).Conclusion:Propofol combined with midazolam for sedation may be associated with a higher sedation success rate and a higher incidence of delirium in patients after oral and maxillofacial surgery.Part ⅢStudy on the safety and efficacy of remimazolam besylate in patients after oral and maxillofacial surgery in ICUObjective:To explore the safety and efficacy of remimazolam in patients with mechanical ventilation after oral and maxillofacial surgery.Methods:This was a single-center,exploratory clinical study,and patients with mechanical ventilation after oral and maxillofacial surgery in ICU were included.The primary endpoint was extubation time.The sedative effects and safety events of remimazolam,propofol and midazolam were compared by one-way ANOVA or Kruskal-Wallis test,Chi-square test or Fisher’s exact test,and Wilcoxon’s rank sum test.Results:The extubation time of remimazolam,propofol and midazolam groups was 2.96h,1.73h and 3.42h,respectively,which showed no significant difference(p=0.781).There were no significant differences among the three groups in terms of weak-up time(p=0.120),sedation success rate(p=0.601),duration of mechanical ventilation(p=0.163).A significant difference of incidence of bradycardia was shown among the three groups(p=0.018).Conclusion:The sedation effects of remimazolam are comparative to propofol and midazolam,and the incidence of safety events was similar to propofol and midazolam except for bradycardia. |
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