Clinical Study Of Dexmedetomidine Sedative And ICU Delirium

Objective:Delirium is a group of acute cognitive impairment syndrome characterized with attention failure,thinking mess,consciousness confusion,and transformation of mental states.The incidence is 35%～80%.Sedatives can cause delirium and change hemodynamic,which may result from interfering the balance of the body’s autonomic nervous system during sedatives administration.At present,midazolam,propofol and dexmetomidine are the most typically used sedatives in China.Therefore,by comparing the incidence and time of delirium of ICU patients treated with midazolam,propofol and dexmetomidine,the separate effects on basic life symptoms and autonomic nervous system were displayed in order to provide reference for clinical sedation drug use.Methods:ICU patients who need sedation and analgesia were randomly divided into midazolam +fentanyl group.(group A),Propofol +fentanyl group(group B),Dexmetomidine +fentanyl group(group C)，Fentanyl(group D).Patients in each group were given continuous intravenous infusion of fentanyl to maintain analgesia with CPOT pain score of 2 points.Group A,B,C were separately given midazolam,propofol and dexmetomidine in order to target the sedative RASS score between-2～0.From the first day of treatment,two research team members or ICU nurses will use the simplified Chinese version of the intensive care unit consciousness fuzzy evaluation method(CAM-ICU)to evaluate patient’ s delirium every 4 h beside the beds and stopped when delirium occurred.The observation lasted for maximum7 days.Systolic blood pressure,diastolic blood pressure,heart rate,oxygen saturation and respiratory frequency were recorded while HRV(LF,HF,LF/HF,TP)Changes were also recorded at 2h before sedative administration and 12h after sedative adminstration.values of Systolic blood pressure,diastolic blood pressure,heart rate,blood oxygen saturation,respiratory rate,LF,HF,LF/IF and TP were mean ± standard deviation.X2 test,ANOVA and survival analysis were performed by SPSS20.0statistical software package.(P<0.05 indicates a statistical difference).The variance was measured by nonparametric test.The test standard is 0.05.Results:1.1.The incidence of delirium in group C was lower than that in group A,B and D,and the delirium occurring time was later than that in group A,B,D(P<0.05).2.The systolic blood pressure,diastolic blood pressure and heart rate of group A did not have statistically significant changes after reaching the target sedation level,(P>0.05);The heart rate in group C was significantly lower than that in group A and B,and the difference was statistically significant.(P<0.05);The systolic blood pressure and diastolic blood pressure in group B were significantly lower than those in group C after sedation,and the difference was statistically significant.(P<0.05).There was no significant difference in respiratory and blood oxygen saturation between group A,B and C before and after treatment.(P>0.05).3.In group A and D,LF,HF decreased at 2 h after sedation featuring significant decreasing HF and increasing LF/HF.In group B,LF,HF,LF/HF decreased at 2 h after sedation featuring significant decreasing LF.In group C,LF,BF decreased at 2 h after sedation featuring significant decreasing LF and slightly increasing LF/HF.In group A and D,HF decreased mainly at 2 hours after sedation,and the difference was statistically significant(P<0.05).A group HF decreased more than the D group.In group B and group C,LF(relative to sympathetic relative excitability)decreased mainly at 2 hours after sedation,and.the difference was statistically significant(P<0.05).The degree of LF decline in group B was higher than that in group C.12 hours after sedation,group A LF,HF decreased,and HF decreased mainly,LF/HF increased;group B LF,HF decreased,and LF.The decrease was predominant,LF/HF decreased,and group C LF and LF/HF decreased.HF increased,and LF decreased significantly;in group D,LF and HF decreased,and HF was elevated;group A and D were treated with sedation for 12 hours.HF The main difference was statistically significant(P<0.05)difference,A degree of decrease is higher than the HF group group D.In group B and group C,LF decreased mainly at 12 hours after sedation,and the difference was statistically significant(P<0.05),C group LF decreased more than B group..Conclusion:1.Dexmetomidine can reduce the incidence of delirium after sedation and analgesia and delay delirium of ICU patients.2.Dexmetomidine had relatively small effect on respiration and circulation of severe patients.3.Under maintenance of low-dose sedations,dexmetomidine can reduce sympathetic nerve excitement and stress of ICU patients,uphold sympathetic and parasympathetic nerve balance and help to maintain homeostasis.