Application of dexmedetomidine on sedation in patients with moderate brain injury

LIU Peng; LIU Kui; HAO Ji-shan

doi:10.3969/j.issn.1009-4237.2017.05.009

Abstract：Objective To study the efficacy of dexmedetomidine on sedation in patients with moderate brain injury. Methods Totally 120 craniocerebral trauma patients who were admitted from Jan.2014 to Dec.2015 were selected as research subjects.In accordance with the random number table, the patients were randomly divided into dexmedetomidine group(n=60) and lytic cocktail group(n=60).In dexmedetomidine group, dexmedetomidine load 0.5-1.0 μg/kg was injected within 10 minutes,and maintaining at 0.2-0.7μg/(kg·h) for 3 days.In lytic cocktail group,lytic cocktail was injected into muscle every 8 hours for 3 days.The factors of the two groups including age,gender,weight,GCS,vital signs(heart rate, mean arterial pressure, blood oxygen saturation),C-reactive protein,adverse reaction,complication,length of stay,prognosis,were analyzed by statistical analysis. Results (1)In dexmedetomidine group ,the data were age(36.2±10.8)years,gender (male/female 38/22),weight (68.3±13.2)kg,GCS score (10.8±3.2).Compared with the lytic cocktail group (34.6±11.2)years,male/female 43/17,(65.5±11.5)kg ,(10.2±2.6), differences were insignificant(P>0.05).(2)Compared with pre-treatment,in dexmedetomidine group the heart rate(72.4±7.8) and MAP (87.8±8.1)mmHghad no difference,but in lytic cocktail group HR (66.2±7.6),MAP (87.8±8.1)mmHg they all declined greatly.No marked changes were detected in blood oxygen saturation of the two groups,the data were (96.4±2.9),(96.2±2.1).(3)C-reactive protein of dexmedetomidine group(32.8±7.1)mg/L and lytic cocktail group(41.2±7.9)mg/L increased and peaked in the 3rd day,but 1 day after admission the growth in dexmedetomidine group(28.5±6.2)mg/L was markedly lower than lytic cocktail group(34.8±7.2)mg/L.(4)The incidence of adverse reaction and complication in dexmedetomidine group were lower than in lytic cocktail group.The numbers of bradycardia,hypotension,stress ulcer,pulmonary infection were 13,10,7,8 in dexmedetomidine group,compared with the numbers of 23,20,16,17 in lytic cocktail group.The incidence rate of light sedation group(3,2,1,1) was significantly lower than that of deep sedation group (10,8,6,7).(5)Length of ICU stay(12.8±5.5)days and total length of stay(21.2±6.5)days of dexmedetomidine group were obviously reduced.The data in lytic cocktail group were (15.3±6.1)days,(28.5±7.4)days.(6)At 6-month follow-up,the numbers of the patients scoring 1 to 5 according to Glasgow Outcome Scale were respectively 3,5,10,15,27 in dexmedetomidine group,while in lytic cocktail group were respectively 5,9,13,16,17.The result of the dexmedetomidine group was better than that of the lytic cocktail group for GOS by Ridit analysis [Ridit(dexmedetomidine)=0.552,Ridit(lytic cocktail)=0.448,P=0.048].There was no significant difference in mortality between dexmedetomidine group and lytic cocktail group (5% vs.8.3%). Conclusion Dexmedetomidine has satisfactory sedative effect,at the same time,it has no effect on respiratory system and circulatory system.Dexmedetomidine can obviously reduce CRP levels,inhibit inflammation response and improve the prognosis of patients.It is suitable for sedation in patients with moderate brain injury.