Study On The Sedative Effect Of The Combined Use Of Dexmedetomidine And Propofol For Patients After Neurosurgical Operation

Objective:To investigate the sedative effect?and prognosis of the combined use of dexmedetomidine and propofol for the patients after neurosurgical operation in the intensive care unit.Methods:A prospective randomized controlled trial was conducted,Patients after neurosurgical operation who were admitted to a comprehensive ICU at the Affiliated Hospital of Guizhou Medical University were randomly divided into propofol group?group P?and dexmedetomidine combined with propofol group?group DP?.First giving the analgesia therapy after two groups of patients transferred to the ICU treatment:both groups used intravenous continuous pump infusion of fentanyl 0.3¹.0?g·kg^-1·h^-1 as an analgesic therapy,and keeping pain score between 0³ according to the Revised Adult Nonverbal Pain Scale?NVPS-R?.Two groups of patients use the Bispectral index monitor?BIS?,recording the per hour sedation scores,increase or reduce sedative drugs according to the sedation score and control the level of sedation in tht Richmond Agitation-Sedation Scale?RASS?scores-2⁰ and BIS value 65-85.The patients of group P continuously received propofol by continuous IV pump infusion propofol at a speed of 0.5⁴.8 mg/?kg·h?.Group DP continuously received dexmedetomidine by continuous IV pump infusion dexmedetomidine at a speed of 0.2⁰.4?g/?kg·h?,at the same time continuously to pump the propofol 0.3¹.0 mg/?kg·h?.Recording the blood pressure,the heart rate?HR?,arterial blood gas,working time,the time of mechanical ventilation,ICU stay time,adverse reactions and 28-day mortality,60-day GlasgowOutcomeScale?GOS?,90-dayGOSofpatientsinboth groups.Results:Propofol group and dexmedetomidine combined with propofol group had 2 cases and 1 patients that were excluded because of ICU stay time less than 48h,1 cases gave up treatment and 1 cases lost follow-up;finally,22 cases of propofol group and 24 cases of dexmedetomidine combined with propofol group were included in the analysis.Compared with propofol group,the working time of dexmedetomidine combined with propofol group was shorter(min:4.1±0.6 vs.5.1±0.9min.The dosage of fentanyl in group DP was lower than in group P?ug·kg-1·h-1:0.4±0.8 vs.0.5±1.0?.The difference was statistically significant?both P<0.01?.The heart rate of two groups decreased with the prolongation of treatment time,and the HR of dexmedetomidine combined with propofol group after treatment was more significantly decreased than propofol group;The respiration and circulation and arterial blood gas analysis index and BIS value in the two groups at each time point after treatment had no significant difference.There was no significant difference in the incidence of adverse reactions between propofol group and dexmedetomidine combined with propofol group[hypotension:13.6%?3/22?vs.12.5%?3/24?,bradycardia:18.2%?4/22?vs.4.1%?1/24?,delirium:4.5%?1/22?vs.8.3%?2/24?both P>0.05].The difference of two groups during mechanical ventilation time,stay ICU time and 28-day mortality was no statistically significant?P>0.05?.Compared with P group,GOS score in DP group was higher?60-day GOS:3.8±1.5 vs.3.0±1.2,90-day GOS:4.0±1.6 vs.3.2±1.4 both P<0.05?.Conclusion:The combined use of dexmedetomidine and propofol can obtain satisfactory sedative effects for patients after neurosurgical operation.Compared with propofol alone,can improve the long-term prognosis score of patients,but easy to cause heart rate to drop.