Clinical Research Of Stress Effects By Daily Interruption Sedation For Mechanical Ventilation Patients

Object:To study the Stress Effects by daily interruption sedation for mechanical ventilation patients; To investigate the feasibility of increasing the frequency of daily interruption sedation for mechanical ventilation patients.Method:Thirty critical patients undergoing mechanical ventilation in ICU which the APACHEⅡ(Acute physiology And Chronic Health EvaluationⅡ, APACHEⅡ) scores>16 points were Randomly divided into three groups:Group I (Control group, n=10) was the group which the patients would be no interrupt sedation a day, groupⅡ(Experimental group, n=10) would be interrupt sedation once a day and the groupⅢ(Experimental group, n=10) twice a day. Sedative, analgesic treatments with closed loop of target controlled infusion of propofol (Target scope of BIS value were set from 80 to 60) and micro pump infusion of fentanyl were all used in each group. MAP, RR, SPO2, HR value, the Ramsay score and the corresponding value of BIS monitoring were observed and recorded per 1 hour; Finger blood glucose monitoring once every 4h; detecting the serum COR,"ACTH concentration at Oh(T0),12h(T1),24h(T2); And the total amount of propofol in 24h were recorded too.Result:The correlation was proved between BIS values and Ramsay scores to each group (rs=0.897, P＜0.001); BIS values in the range of 60 to 80, the time percentage was 79.9%. Three groups on the dosage of propofol was no significant difference (P>0.05). There were no significant difference among MAP, SPO2, HR, RR comparing with the basic values in each group (P>0.05) and no significant difference to MAP, SPO2 among three groups; but the HR, RR of group III were more higher than the other two groups (P<0.05). In groupⅠ, the values of ACTH decreased firstly(T1) and then increased (T2), T1 to T0, T2 to T1, have significant difference (P<0.05).T2 to T0, has no significant difference (P>0.05); The ACTH of groupⅡ,Ⅲwere increased and there have significant difference between T2 with T0, T1 but no significant difference between T1 with T0. The COR of group I were reduced and there have significant difference between T1 with To, but no significant difference between T2 with T0, T1. In groupⅡ, the values of COR decreased firstly(T1) and then increased (T2), T1 to T0 has no significant difference (P>0.05); T2 to T0, T1 have significant difference (P＜0.05). And the values of COR of group III were all increased and there was significant difference between T2 and T0 (P<0.05). There were no significant difference at the time points (T0, T1, T2) in the values of ACTH and COR among the three groups. The values of blood glucose have no significant difference among three groups.Conclusion:1. With the increased of daily interruption sedation to mechanical ventilation critical patients, the stress effects were increased too; 2. Daily interruption sedation in mechanical ventilation critical patients is safe and feasible, not to increase the accident rate.