Application Of Dexmedetomidine In The Patient With Mechanical Ventilation In The ICU Observation

Objective Patients used dexmedetomidine for ICU mechanical ventilation were observed in calm and the clinical effect of anti-inflammatory, and less likely to cause delirium.Methods Patients were choosed with60cases in October2012to October2013, changzhi medical college affiliated peace hospital respiratory failure caused by lung infection in the ICU to need breathing machine in auxiliary ventilation. According to random method the subjects were divided into midazolam groups (control group),30cases, Dexmedetomidine (experimental group)30cases. Midazolam group male17cases,13cases of female, aged20to65years old,40-90kg, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score was8.3±3.1on average. Dexmedetomidine19cases, male female in11cases, aged22to60,45-85kg, APACHE Ⅱ average score was8.4±3.2. Mainly for the lung infection, eliminate craniocerebral trauma; Severe liver and kidney function damage; Bradycardia. Hemodynamic instability, by asoactie drugs patients maintain. According to the chest radiograph shows patients were divided into chronic obstructive pulmonary disease patients acute pneumonia, pure, traumatic wet lung infection. Midazolam group with midazolam0.05-0.1mg/kg slow intravenous infusing, at the rate of2mg/min, intravenous maintenance dose of0.05-0.2mg/(kg. h) were continuoused pumping; Dexmedetomidine group to hydrochloric acid Dexmedetomidine lug/kg intravenous injectionwere pumped10min. Maintenance dose of0.2to0.7ug/(kg. h) for pumping. We line auxiliary breathing through breathing machine, conventional intensive care, including breathing machine parameters, heart rate, blood pressure, electrocardiogram, blood oxygen saturation determination monitor and blood gas analysis at the same time, open the vein channel besides. Before use breathing machine c-reactive protein and calcitonin original were checked to reflect inflammation reaction. After48hours the review of c-reactive protein and calcitonin original, observing whether inflammation is relieved. Patients of discontinual calm exercised daily wake-up strategy to evaluate awakening time. Two groups of patients were observed with ventilator to offline for consuming time and compaired. Calm in the process of machine evaluated was also called Ramsay, Ramsay Ⅱ-Ⅳ and collected cases. Ⅰ, patients’ anxiety, restlessness;Ⅱ level:patients cooperate, there are directional force, quiet; Ⅲ, patients respond to commands;Ⅳ, lethargy, for tapping eyebrow or loud auditory stimuli responsive; Ⅴ, lethargy, for tapping eyebrow or slow to respond to auditory stimuli with a loud voice; Strong level Ⅵ lethargy, for tapping the eyebrow or no response, sound stimulation. Presence of delirium occurring, and so on and so forth. Statistical processing USES SPSS13.0statistical software for statistical analysis, the experimental data are used to mean+standard deviation (x±S) said, to do first variable normality test, using single sample independent test and paired test, P<0.05said the difference was statistically significant.Results For general data to compare the two groups, there was no statistically significant difference; Ramsay Ⅱ～Ⅳ level grading, treatment group than the control group, but there was no statistical difference meter. P>0.05. Machine and awakening time trial group significantly shorter than the control group, the incidence of delirium experimental group is lower than the control group, the difference was statistically significant P<0.05. C-reactive protein and calcitonin original, test group significantly lower after treatment than before treatment, the difference is statistically significant P<0.05, while the control group did not change significantly before and after treatment.conclusion Dexmedetomidine and midazolam for sedation are similar in mechanical ventilation; Dexmedetomidine group of awakening time, average machine time are significantly shorter than midazolam group, at the same time can reduce c-reactive protein and calcitonin original; Dexmedetomidine in calm, inhibiting inflammation factor has obvious advantages, and controls of delirium.