Clinical Study Of Dexmedetomidine Combined With Propofol For Elderly Obesities Undergoing Mechanical Ventilation In Intensive Care Unit

Objective: To investigate sedative effect and safety of dexmedetomidine combined with propofol for elderly obesities undergoing mechanical ventilation in intensive care unit(ICU).Methods: Sixty patients in ICU of Liyuan hospital, Nov. 2013 older than 65, body mass index(BMI) more than 28 kg.m-2, acute physiology and chronic health evaluation(APECHE II) score: 10~25, requiring mechanical ventilation, were randomly divided into dexmedetomidine group(group D, n=20), propofol group(group P, n=20) and dexmedetomidine combined with propofol group(group C, n=20). In all groups fentanyl was given intravenously continually for analgesia, dose was kept on 0.30?g/h and regulated according to CPOT(critical-care pain observation tool) scores maintaining in 0-1 analgesic score. All groups were given corresponding drugs for sedation, dose was regulated according to RASS(Richmond agitation-sedation scale) score maintaining at the target value(-1 to 2). During the course, alanine aminotransferase(ALT), Aspartate aminotransferase(AST), triglycerides(TG), total cholesterol(TC), dosage of fentanyl, the mechanical ventilation time, awakening time, residence time in ICU, positive rate of delirium and side effect such as hypotension were observed and recorded continuously.Results: Each group could reach the goal of sedation needed for ICU patients. The dosage of fentanyl was less in groups D and C than in group P(P<0.05), and no significant difference between group D and group C(P>0.05). After 3 days of treatment, all the groups' ALT and AST elevated mildly. Compared with group P, groups C and D elevated less(P<0.05), but there was no significant difference between group C and group D(P>0.05). TG and TC in group D stayed the same after 3 days' treatment(P>0.05), while groups C and P elevated(P<0.05), and group C elevated less(P<0.05). The time of mechanical ventilation was shorter in group C than in the other two groups(P<0.05), and group P was the longest one. The residence time in ICU in was shorter in group C than in the other two groups(P<0.05), and no significant difference between group D and group P(P>0.05). There was no significant difference in awakening time and the positive rate of delirium in all groups(P>0.05). Significant difference in the positive rate of hypotension was found between group C and group D(P<0.05), and it was the only difference.Conclusion: Dexmedetomidine combind with propofol can reach the goal of sedation needed for elderly obesities in ICU, it helps to shorten the dosage of dexmedetomidine and propofol, maintains the respiratory and circulation parameters, and reduces adverse and side reactions.