Sedative effect of combination dexmedetomidine and propofol for patients with severe brain injury
10.3969/j.issn.1008-9691.2018.02.003
- VernacularTitle:联合用药对重症脑损伤患者的镇静效果观察
- Author:
Huan XU
1
;
Difen WANG
;
Ying LIU
Author Information
1. 贵州医科大学
- Keywords:
Dexmedetomidine;
Propofol;
Sedation;
Brain injury
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2018;25(2):127-132
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the sedative effect and prognosis of combination of dexmedetomidine and propofol for the patients with severe brain injury. Methods A prospective randomized controlled trial was conducted. Fifty-three patients with severe brain injury admitted to intensive care unit (ICU) of Guizhou Medical University Affiliated Hospital from October 2016 to March 2017 were enrolled, and they were randomly divided into propofol group (n = 28) and dexmedetomidine combined with propofol group (combination group, n = 25). The patients in the two groups were treated with intravenous infusion of fentanyl 0.3 - 1.0 μg·kg-1·h-1after ICU admission for analgesia, and maintained the analgesic score at 0 - 3. The dosage of sedative drugs was adjusted, the bispectral index monitor (BIS) was continuously monitored, and maintained the Richmond agitation-sedation scale (RASS) score at -2 to 0, and BIS at 65 - 85. Additionally, the patients in propofol group were continuously received propofol by continuous intravenous pump at a speed of 0.5 - 4.8 mg·kg-1·h-1, and those in combination group continuously received dexmedetomidine 0.2 - 0.4 μg·kg-1·h-1and propofol 0.3 - 1.0 mg·kg-1·h-1. The parameters of respiratory, circulatory and arterial blood gas analysis, drug onset time, duration of mechanical ventilation, the length of ICU stay, adverse reactions, 28-day mortality, and 60-day and 90-day Glasgow outcome scale (GOS) score in both groups were recorded. Results There were 2 patients and 1 patient who were excluded because of the length of ICU stay less than 48 hours, 1 case gave up treatment and 1 case lost follow-up in propofol group and combination group, respectively. Finally, 24 patients in propofol group and 22 in combination group were enrolled in the analysis. Compared with propofol group, the drug onset time of combination group was shortened (minutes: 4.1±0.6 vs. 5.1±0.9). the dosage of fentanyl was lowered (μg·kg-1·h-1: 0.4±0.1 vs. 0.5±0.1), with significant differences (both P < 0.01). The heart rate (HR) of two groups decreased with the prolongation of treatment time, and the decrease in HR of combination group was more significant than that of propofol group from 30 minutes to 12 hours after treatment (bmp: 82.3±11.0 vs. 90.0±12.8 at 30 minutes, 78.1±8.2 vs. 90.8±9.3 at 12 hours, both P < 0.05). There was no significant difference in the parameters of circulatory and arterial blood gas analysis or BIS between the two groups. There was also no significant difference in the incidence of adverse reactions between propofol group and combination group [hypotension: 12.5% (3/24) vs. 13.6% (3/22), bradycardia:4.1% (1/24) vs. 18.2% (4/22), delirium: 8.3% (2/24) vs. 4.5% (1/22), all P > 0.05]. The difference in duration of mechanical ventilation, the length of ICU stay or 28-day mortality showed no statistical significance between the two groups, but 60-day (3.8±1.5 vs. 3.0±1.2) and 90-day (4.0±1.6 vs. 3.2±1.4) GOS scores in combination group were significantly higher than those of propofol group (both P < 0.05). Conclusion The combined use of dexmedetomidine and propofol can obtain satisfactory sedative effects for severe brain injury patients, which can reduce the dosage of analgesic drugs, improve the long-term prognosis as compared with propofol alone, but easy to cause HR to decrease.
