| Purpose: To analyze whether it is safe and efficient to use dexmedetomidine onpatients in ICU for sedation and analgesia during extubation and find the best way forthose patients to release pain.Methods:90ICU patients who were in their extubation period from march2012to march2013were selected randomly from the First Affiliated Hospital ofZhengzhou University. Those patients were transformed into ICU after generalanesthesia,and they have to use ventilators for breathing and circulating. Theaverage time spent on ventilation is58hours. Their ages varied from52to75yearsold, and average age was67years old.53of them are male cases, and37werefemale. They were randomly divided into3groups: control group (group A) anddexmedetomidine group (group B), which was divided into two subgroups (B1, B2).Each group had30patients. Under the circumstance that those patients remained anunstable condition, ventilators are not required here.After patients’ waking up, wecontinue to give them fentanyl midazolam for complete sedation. Vecuronium0.1mg/kg are given to reduce the oxygen consumption and the adverse consequencescaused by agitation when necessary. Patients under assessment can be off ventilator,they will be changed to use short acting sedative drugs. We input propofol infusionto Group A with1mg/kg intravenous, and then made1-5mg/kg.h continuousintravenous pumping. Group B1, B2received dexmedetomidine loading dose of1ug/kg with intravenous infusion of l0min, and then they were given to maintaincontinuous intravenous infusion dose of0.5ug/kg/h and0.7ug/kg/h. The drugs can bestopped when patients can breathe by themselves and ventilators are no longer needed.T1means the record before treatment; T2means record1hours after usingdexmedetomidine; T3means the record about the recovery of spontaneous breathing;T4was recorded5min before extubation; T5was recorded during extubation; T6means record5min after extubation. The record includes systolic blood pressure(SBP), diastolic blood pressure (DBP), heart rate (HR), respiration, blood oxygensaturation numerical, and three groups of patients during the extubation assisted drug morphine dosage, adverse reactions and the number of cases. And also we observe thepossible agitation, hypertension, hypotension, respiratory depression, nausea andvomiting,as well as slow and shivering heartbeat.Outcome: All three groups had no significant difference in sex ratio, age,weight and height(P>0.05). At the same time of extubation, Group A patients’systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) weresignificantly increased compared with the result before treatment, this showsstatistical significance (P<0.05), B1, B2groups patients’ heart rate (HR) had noobvious change (P>0.05), and in group A the patient’s heart rate and blood pressurewere distinctly higher than those of B1and B2. This also shows statistical significance(P<0.05). In the extubation period, patients in B1, B2group were treated with lessmorphine dose than A group (P<0.05), and the rate of adverse reaction in B1, B2groups were lower than those in A group.At the same time, the B1group had lessadverse reaction than B2. Three groups of patients’ blood oxygen saturation had nostatistical significance (P>0.05) before and after sedation and respiration.Conclusions: For ICU patients, using dexmedetomidine for sedation andanalgesia during extubation is firstly safe and effective. It helps patients wake up witha better quality and reduce the time spent on extubation. Secondly, it can effectivelymaintain a stable hemodynamics and remain the chance of happening adversereactions lower. The effects of Dexmedetomidine sedation and analgesia aredependent on the amount used. It will make a patient’s hemodynamic state morestable during extubation, reduce the pain and cough.A continuous intravenousinfusion of0.5ug/kg.h of sedative dexmedetomidine hydrochloride is better, whichdoes not affect the recovery time and the complication of respiratory. As aconsequence, it is more suitable for ICU patients after extubation.
|
PDF Full Text Request