Effect of prolonged sedation with propofol and dexmedetomidine on acute gastrointestinal dysfunction injury and prognosis in ICU patients

Abstract

Objective To investigate the effect of prolonged sedation with propofol and dexmedetomidine on acute gastrointestinal dysfunction injury(AGI) and prognosis in intensive care unit(ICU) patients. Methods A prospective cohort study was conducted to collect 200 cases of mechanical ventilation patients admitted to ICU in the Second People's Hospital of Hefei, and the patients were divided into two groups according to the simple random grouping principle, with 100 cases in each group.The control group was given propofol sedation, and the research group was given propofol combined with dexmedetomidine sedation.Both two groups were given sufentanil for analgesia, and the basic clinical data of the patients were recorded, including age, gender, weight, BMI index, serum albumin levels, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, triglycerides (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST). On the 0th and 7th day after the use of sedatives, the intestinal singing score, cases of acute gastrointestinal dysfunction injury, cases of delirium, length of stay in the ICU and hospitalization costs, TG, TC, ALT and AST in the two groups were observed and compared. Results The TG, TC, ALT and AST levels were all increased in the two groups compared with those at the 0d, but the increase degree in the study group was lower than that in the control group, and the differences were statistically significant (t=3.87, 4.58, 5.26, 4.38, P=0.00, 0.00, 0.00, 0.00). A total of 85 patients in the control group developed AGI, and 70 patients in the study group developed AGI.The difference between the two groups was statistically significant (χ2=8.62, P=0.03), and the difference in intestinal sound score between the two groups was statistically significant (χ2=11.48, P=0.00). There were 13 delirium cases in the control group and 2 delirium cases in the study group, and the difference was statistically significant (χ2=11.83, P=0.00). There were no statistically significant differences in the length of hospital stay(t=1.64, P=0.10) and hospital expenses(t=1.28, P=0.20) between the two groups. Conclusion For ICU patients requiring long-term mechanical ventilation, dexmedetomidine can significantly reduce the incidence of delirium and the occurrence of AGI, especially for obese patients, the use of dexmedetomidine sedation has little impact on their liver function and blood lipid metabolism, and can significantly improve the prognosis. Key words: Drug therapy, combination; Deep sedation; Intensive care units; Critical illness; Respiration, artificial; Gastrointestinal dysfunction; Delirium; Propofol; Dexmedetomidine