| BackgroundAcute respiratory distress syndrome(ARDS)is mainly characterized by injury of alveolar capillary endothelium and alveolar epithelial cells,and is characterized by acute diffuse lung injury characterized by intractable hypoxemia.Most patients require mechanical ventilation support.Dexmedetomidine is one of the sedative drugs.In recent years,it has been reported that it has a protective effect on the heart,brain and kidney during sedation and anesthesia.Animal experiments have shown that dexmedetomidine can produce lung protection in animal models of lung injury and can also exert inhibitory effects on inflammatory factors in blood.It was also reported that dexmedetomidine also showed anti-inflammatory effects in patients with sepsis,and lung protective effect of dexmedetomidine was also observed in human lung epithelial cells in vitro.but there are relatively few in vivo studies in patients with ARDS of dexmedetomidine anti-inflammatory effects.ObjectiveBy maintaining the same depth of sedation as traditional intravenous tranquillizing propofol,to compare the effect of dexmedetomidine on oxygenation index(OI)and inflammatory factors in peripheral blood of patients with endogenous ARDS and to discuss the clinical efficacy of dexmedetomidine Lung protection and anti-inflammatory effects.MethodsSelected ICU patients with intrapulmonary ARDS as a research object from January 2016 to January 2018 in our hospital.A total of 76 related cases were included and divided into dexmedetomidine group(P group)and propofol group(C group),with 39 cases in P group and 37 cases in C group.The two groups of patients were given either dexmedetomidine or propofol to maintain Ramsy sedation ratings of 3-5.Arterial blood oxygenation index(OI),PaCO2,TNF-?,IL-6,full range of CRP,PCT,CysC,RBP were measured at intubation(T0),sedation 6h(T1),12h(T2),24h(T3)in the two groups.Measure T0,T3 Scr of two groups of patients.SPSS 23.0 software was used for statistical data analysis.Results1.There was an interaction between the time of OI and the treatment effect in the two groups(F=5.722,P=0.001).The single effect analysis showed that there was a difference between the groups at T2(t=2.952,P=0.004).The OI values of the two groups showed a decreasing trend overall,but the P group decreased slowly;2.There was no interaction between the two groups in the overall analysis of PaCO2(F=1.426,P=0.236),and the main effect analysis had no statistically significant time effect(F=2.223,P=0.086).There was no statistical significance between treatment groups in T0.(t=0.284,P=0.777);3.There was an interaction between TNF-?,IL-6,and PCT in the two groups(F=11.631,31.582,22.440,P=0.000,0.000,0.000).The single effect analysis showed that there were differences between the two groups at the T2 time point(t=-3.392,-5.124,-4.561,P=0.001,0.000,0.000),and the indicators of the two groups showed an overall upward trend,but the P group increased slowly;4.There was an interaction between the whole CRP analysis of the two groups(F=10.344,P=0.000).The single effect analysis showed that there was a difference between groups at T1(t=-2.556,P=0.013).The overall CRP of both groups showed an upward trend.,but the P group rose slowly;5.There was an interaction between CysC and RBP in the two groups(F=4.268,5.923;P=0.006,0.000).There was an inter-group difference in CysC at T2(t=3.466,P=0.001)and in RBP at T1(t=-3.971,P=0.000).Interactive graph shows that CysC indicators are slowly rising in both groups.The RBP indicator is slowly rising in the P group,while group C is flat.All indicators are not above the upper limit of the normal range;6.There was no significant difference between the two groups of patients before and after study in the Scr(P>0.05).Conclusions1.Equivalent to propofol sedation depth,dexmedetomidine can delay the deterioration of pulmonary oxygenation in patients with endogenous ARDS;2.Equivalent to propofol sedation depth,dexmedetomidine can delay the synthesis and release of inflammatory factors in peripheral blood of endogenous ARDS. |
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