Comparison of the effects of dexmedetomidine and propofol on sedation in patients with short-term mechanical ventilation after elective surgery

QIAO Li; YUAN Hongxun; ZHAO Huiying; WANG Zheng; AN Youzhong

doi:10.3969/j.issn.1674-3806.2024.06.17

Abstract：Objective To compare the effects of dexmedetomidine and propofol on sedation in patients with short-term mechanical ventilation after elective surgery.Methods A total of 97 patients who were returned to the intensive care unit(ICU)with tracheal intubation after surgery under general anesthesia in Peking University International Hospital from April 1,2022 to November 30,2023 were recruited.All the patients underwent short-term(＜24 hours)tracheal intubation mechanical ventilation,continuous sedation and analgesia.The patients were divided into observation group(49 cases,intervention with dexmedetomidine)and control group(48 cases,intervention with propofol)by using random number table method.The use of antihypertensive drugs(nicardipine hydrochloride)during ICU observation was recorded in the two groups.The vital signs indicators[heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)],plasma catecholamine[epinephrine(E),norepinephrine(NE)]levels before sedation(T0),1 hour after sedation(T1)and 2 hours after tracheal extubation(T2)between the two groups and between the subgroups using antihypertensive drugs,and the incidence of delirium was recorded in the two groups.Results At the time points from T0 to T2,HR and MAP showed a downward trend and then an upward trend,and RR showed a stable trend and then an upward trend,and E showed an upward trend and then a downward trend and NE showed a continuous upward trend in the two groups,and there was statistically significant difference in the changing amplitude of NE between the two groups(P＜0.05),and at the time point of T2,the NE level in the observation group was significantly lower than that in the control group(P＜0.05).During ICU period,there were 2 cases of delirium in the observation group and 2 cases in the control group,and there was no significant difference in the incidence of delirium between the two groups(4.08％vs 4.17％;P=1.000).There were 12 patients in the observation group and 11 patients in the control group who used antihypertensive drugs during ICU period,and there was no statistically significant difference in the utilization rate of antihypertensive drugs between the two groups(24.49％vs 22.92％;x2=0.033,P=0.885).For the patients using antihypertensive drugs,there were no significant differences in the duration of antihypertensive medication use and the total dose of antihy-pertensive drugs between the two groups(P＞0.05).Among the patients using antihypertensive drugs,E in the obser-vation group showed an upward trend and then a downward trend,while E in the control group showed an upward trend,and there was statistically significant difference in the changing amplitude of NE between the two subgroups(P＜0.05),and at the time point of T2,the NE level of the observation group was significantly lower than that of the control group(P＜0.05).In the patients who did not use antihypertensive drugs,the levels of HR,MAP and NE at the time point of T2 in the observation group were lower than those in the control group,and the differences were statistically significant between the two groups(P＜0.05).Conclusion The use of dexmedetomidine for sedation results in less blood pressure fluctu-ations,lower plasma catecholamine levels and stronger inhibition of the sympathetic nervous system in patients before and after extubation.