Effects Of Different Doses Of Dexmedetomidine On Prognosis Of Patients With Sepsis Acute Kidney Injury

Objectives To observe and compare the effects of dexmedetomidine（DEX）at different dose levels on the prognosis of patients with sepsis acute kidney injury（SAKI）to provide a reference for SAKI patients to choose the appropriate dose of DEX in the future.Methods From November 2020 to December 2021,we selected 90 patients who were hospitalized in the Intensive care unit of the Affiliated Hospital of North China University of science and technology and who were definitely diagnosed as SAKI.The patients were randomly divided into low dose group（D₁ group 0.25μg/kg/h）,medium dose group（D₂group 0.50μg/kg/h）and high dose group（D₃ group 0.75μg/kg/h）by random number table method.All patients were treated with active fluid resuscitation,antimicrobial therapy,hemodynamic support,and nutritional support.On this basis,all patients were treated with different doses of DEX.To observe and compare 3 group patients of each group with DEX before pumping（T₀）,DEX after pumping 24h（T₁）,48h（T₂）,64h（T₃）,96h（T₄）at the same time,a different group of the general situation APACHE II score and SOFA score;renal function indicators:Scr,BUN,UA,24h urine volume,24h urine albumin quantification,β₂-MG,NGAL;inflammatory indicators:CRP,PCT;The dosage of norepinephrine per unit time,remifentanil dosage and ICU stay time of patients in the three groups were recorded.The incidence of adverse events,such as bradycardia,tachycardia,delirium and CRRT cases,was summarized and compared among 3 groups during hospitalization.Results There was no significant difference in age,gender,BMI,hypertension and diabetes among the three groups（P>0.05）.Intra-group comparison:APACHE II score,SOFA score,Scr,BUN,UA,CRP,PCT,NGAL,urinary albumin and urineβ₂-MG at T₁-T₄in 3 groups were all lower than T₀,24h urine volume was higher than T₀,the difference was statistically significant（P<0.05）.Comparison between groups:there were no significant differences in PCT,CRP,NGAL,urinary albumin at T₀,APACHE II score,SOFA score,BUN,β2-MG and Scr at T₀-T₁ among the three groups（P>0.05）.There were statistically significant differences in CRP,NGAL and urinary albumin at T₁-T₄,APACHE II score,SOFA score,BUN,β2-MG at T₂-T₄,Scr,UA and PCT at T₃-T₄ compared with D₂ and D₃groups（P<0.05）.There was no significant difference between D₂ and D₃ groups（P>0.05）.There were no significant differences in the dosage of remifentanil per unit time,the incidence of tachycardia and delirium among 3 groups（P>0.05）.The incidence of bradycardia in D₁ and D₂groups was lower than that in D₃ group,and the dosage of norepinephrine per unit time,the incidence of CRRT and the length of ICU stay in D₁ group were higher than those in D₂and D₃ group,the differences were statistically significant（P<0.05）.The remaining differences were not statistically significant（P>0.05）.Conclusions For SAKI patients,DEX was added on the basis of active fluid resuscitation,antimicrobial therapy,hemodynamic support,and nutritional support.The dosage of DEX was 0.50μg/kg/h,which was better for the improvement of patients’condition and the protection of renal function,and could effectively inhibit inflammatory response and reduce the application of vasoactive drugs.Reduce the incidence of bradycardia and other adverse reactions and hospital stay.It provides a basis for selecting the optimal dose of DEX for the clinical treatment of SAKI patients in the future.Figure 0;Table 7;Reference 141...