Effect of Dexmedetomidine -based early goal-oriented sedation strategy on gastrointestinal function in patients with sepsis

doi:10.3877/cma.j.issn.2096-1537.2019.04.005

Abstract

Abstract:

Objective

To investigate the effect of early goal-oriented sedation strategy on gastrointestinal function in sepsis patients with different sedatives.

Methods

A randomized controlled study was conducted on patients with sepsis who were admitted to ICU of Zhuji Hospital of Traditional Chinese Medicine consecutively from January 2017 to February 2019. Sepsis patients were randomly divided into three groups: Dex group (n=31), Mid group (n=30) and Pro group (n=32). All three groups of patients adopted early goal-directed sedation (EGDS) based on the sufficient analgesia of butorphanol tartrate. Dex group was sedated with Dexmedetomidine, Mid group with Midazolam, Pro group with Propofol. Gastrointestinal indexes (DAO, IFABP and AGI grading) at day 1 (T1), day 3 (T3) and day 7 (T7) were recorded in the three groups. Average daily dose of analgesics, daily costs of sedation and analgesia during hospitalization, mechanical ventilation time, length of ICU stay, vasoactive drug usage, and delirium incidence were also recorded.

Results

(1) gastrointestinal injury indexes: Dex group was significantly lower than Mid group and Pro group, and the differences in the interaction between the indexes, time points and between groups were statistically significant (P<0.05). There was no significant difference between the two groups (P>0.05). (2) AGI grading: Dex group was significantly lower than Mid group and Pro group, and the difference was statistically significant (P<0.05). (3) Average daily dose of analgesics, the average daily cost of sedation and analgesia, mechanical ventilation time, delirium incidence and 28-day mortality in Dex group were significantly reduced compared with Mid group and Pro group, and the differences were statistically significant (P<0.05). The utilization rates of Atropine and Isopropyl were significantly higher in the Dex group than in the Mid group and the Pro group (P<0.05). There was no significant difference in Norepinephrine usage (P>0.05).

Conclusion

The sedative and analgesic regimen of Dexmedetomidine combined with Butorphanol tartrate can improve the gastrointestinal function of patients with acute gastrointestinal injury caused by sepsis, reduce AGI grading, reduce mechanical ventilation time and reduce the incidence of delirium.

Key words: Sepsis, Acute gastrointestinal injury, Dexmedetomidine, Butorphanol tartrate, Early goal-directed sedation

Yifei Wang, Wenhong Xu, Guofa Li, Yue Li, Yang Zhou, Huanggang Ma, Weidong Zhu, Yunhua Zhang. Effect of Dexmedetomidine -based early goal-oriented sedation strategy on gastrointestinal function in patients with sepsis[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(04): 317-324.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2019.04.005

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Figures/Tables 6

References 27

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一般资料		Dex组（n=31）	Mid组（n=30）	Pro组（n=32）	统计值	P值
年龄（岁，±s）		74.13±10.69	75.87±10.92	70.63±8.60	F=2.180	0.119
男性［例（%）］		24（77.40）	21（70.00）	18（56.25）	χ²=3.333	0.189
SOFA评分（分，±s）		8.23±1.23	8.07±1.46	8.06±1.50	F=0.137	0.872
APACHEⅡ评分（分，±s）		20.97±5.64	20.70±5.85	22.59±5.35	F=1.047	0.355
SOFA评分脓毒症感染部位［例（%）］					χ²=5.287	0.871
	呼吸系统	16（51.61）	12（40.00）	17（53.13）
	消化系统	2（6.45）	5（16.67）	4（12.50）
	泌尿系统	4（12.90）	3（10.00）	4（12.50）
	血行感染	4（12.90）	5（16.67）	2（6.25）
	颅内感染	2（6.45）	3（10.00）	1（3.13）
	其他部位	3（9.68）	2（6.67）	4（12.50）

一般资料		Dex组（n=31）	Mid组（n=30）	Pro组（n=32）	统计值	P值
年龄（岁，±s）		74.13±10.69	75.87±10.92	70.63±8.60	F=2.180	0.119
男性［例（%）］		24（77.40）	21（70.00）	18（56.25）	χ²=3.333	0.189
SOFA评分（分，±s）		8.23±1.23	8.07±1.46	8.06±1.50	F=0.137	0.872
APACHEⅡ评分（分，±s）		20.97±5.64	20.70±5.85	22.59±5.35	F=1.047	0.355
SOFA评分脓毒症感染部位［例（%）］					χ²=5.287	0.871
	呼吸系统	16（51.61）	12（40.00）	17（53.13）
	消化系统	2（6.45）	5（16.67）	4（12.50）
	泌尿系统	4（12.90）	3（10.00）	4（12.50）
	血行感染	4（12.90）	5（16.67）	2（6.25）
	颅内感染	2（6.45）	3（10.00）	1（3.13）
	其他部位	3（9.68）	2（6.67）	4（12.50）

组别	例数	DAO			IFABP
组别	例数	T1	T3	T7	T1	T3	T7
Dex组	31	4.61±2.13	3.42±2.13	2.97±1.61	805.31±488.15	391.38±231.52	348.87±223.74
Mid组	30	4.89±4.17	4.57±2.82^a	4.01±2.96^a	719.18±407.76	651.23±254.61^a	591.90±288.12^a
Pro组	32	4.52±2.41	3.92±2.32	3.40±1.90	804.46±515.61	539.94±402.00^a	380.56±250.60^b
F值		F交互=0.584，F组间=3.859，F时间=3.761			F交互=3.831，F组间=3.271，F时间=23.940
P值		P交互=0.674，P组间=0.025，P时间=0.025			P交互=0.025，P组间=0.043，P时间<0.01
整体分析		HF系数=1，P=0.663			HF系数=0.632，P<0.01

组别	例数	DAO			IFABP
组别	例数	T1	T3	T7	T1	T3	T7
Dex组	31	4.61±2.13	3.42±2.13	2.97±1.61	805.31±488.15	391.38±231.52	348.87±223.74
Mid组	30	4.89±4.17	4.57±2.82^a	4.01±2.96^a	719.18±407.76	651.23±254.61^a	591.90±288.12^a
Pro组	32	4.52±2.41	3.92±2.32	3.40±1.90	804.46±515.61	539.94±402.00^a	380.56±250.60^b
F值		F交互=0.584，F组间=3.859，F时间=3.761			F交互=3.831，F组间=3.271，F时间=23.940
P值		P交互=0.674，P组间=0.025，P时间=0.025			P交互=0.025，P组间=0.043，P时间<0.01
整体分析		HF系数=1，P=0.663			HF系数=0.632，P<0.01

组别	例数	AGI发生情况
组别	例数	APACHEⅡ<10分	APACHEⅡ10~20分	APACHEⅡ>20分
Dex组	31	4（0）	20（35.00）	7（100.00）
Mid组	30	6（16.67）	18（77.78）	6（100.00）
Pro组	32	3（0）	22（68.18）	7（95.00）
χ²值		1.264	8.192	1.955
P值		0.532	0.017	0.376

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