Evaluation Of Butorphanol In Combination With Dexmedetomidine For Analgesia And Sedation In ICU Traumatic Patients Undergoing Mechanical Ventilation

Objective: To investigate the efficacy and safety of butorphanol combined with dexmedetomidine for analgesia and sedation in ICU traumatic patients undergoing mechanical ventilation.Methods: The clinical data of ICU traumatic patients with mechanical ventilation in Huangshan People’s Hospital from January 1,2018 to December 31,2018 were retrospectively analyzed.According to the strategy of analgesia and sedation,21 cases were divided into observation group(butorphanol combined with dexmedetomidine)and 24 cases were divided into control group(fentanyl combined with midazolam).The effective indexes included CPOT and RASS scores of analgesia and sedation after 12 hours,the initial time to achieve the target scores of analgesia and sedation,the waking time after withdrawal,the number of cases with extra use of propofol,and the rate of satisfactory sedation.Observed security evaluation indicators included the incidence of low heart rate and hypotension,acute gastrointestinal injury(AGI)grade II and above,unintended extubation as well as delirium.Meanwhile,the duration of mechanical ventilation and ICU stay were compared between the observation group and the control group.Results: There were no significant differences in age,gender,oxygenation index(PO2/FIO2),shock,CPOT and RASS scores on admission,APACHE II scores on the first day,and trauma region between the two groups(P > 0.05).After 12 hours of sedation and analgesia,the CPOT and RASS scores in the both groups were significantly lower than the initial scores(P < 0.05),but there was no significant difference between the two groups(P > 0.05).The initial time to reach the target analgesia and sedation score in the observation group was(10.43±3.85)minutes,while it was(4.33 ±3.29)minutes in the control group,which suggested that it was significant longer time to reach target analgesia and sedation score in the observation group than in the control group(P < 0.05).The waking time of the observation group was(13.90±6.91)minutes,while that of the control group was(23.21 ±16.41)minutes,that is,the waking time in the observation group was shorter than in the control group with a statistically significant difference(P < 0.05).There were 4 and 2 cases with additional use of propofol due to the dissatisfaction of analgesia and sedation in the two groups,respectively,without significant difference(P > 0.05).The satisfactory rate of sedation in the observation group was(91.68±8.61)%.Unsatisfactory sedation was mainly attributed to inadequate sedation and excessive sedation.The satisfactory rate of sedation in the control group was(78.48±12.38)%.Unsatisfactory part was mainly excessive sedation.The satisfactory rate of sedation in the observation group was much higher than that in the control group(P < 0.05).There were respectively 3 and 1 cases of low heart rate,6 and 4 cases of hypotension in the observation group and the control group,without significant difference between the two(P > 0.05).By the way,after active treatment,these adverse reactions could be improved in a short time.There were2 patients with AGI grade II or above in the observation group and 5 ones in the control group with no significant difference between the two groups(P > 0.05).2 and 9 cases of delirium were observed in the observation group and in the control group,and the rate of delirium in the observation group was lower than that in the control group(P < 0.05).No unintended extubation occurred in both groups.Also,there was no significant difference in the duration of mechanical ventilation and ICU stay between the two groups(P > 0.05).Conclusion: Butorphanol combined with dexmedetomidine can achieve satisfactory analgesic and sedative effects in ICU traumatic patients undergoing mechanical ventilation.It can also achieve accurate analgesic and sedative goals and reduce delirium during the maintenaning stage of sedation and analgesia.However,there is a certain incidence of low heart rate and hypotension when butorphanol combined with dexmedetomidine is used for analgesia and sedation,which needs to be monitored.