镇痛镇静对重型脑损伤患者心率变异性及血清儿茶酚胺变化的影响  被引量:10

The Effects of Analgesic and Sedative on the Heart Rate Variability and Plasma Catecholamine in Patients after Severe Brain Injury

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作  者:丘培利 肖建敏[2] 王开宇[1,2] 龚书榕[1,2] 叶勇[1,2] 许镜清 于荣国[1,2] 

机构地区:[1]福建省立医院重症医学三科,福州350001 [2]福建医科大学省立临床医学院,福州350004 [3]福建医科大学附属龙岩市第一医院麻醉科,龙岩364000

出  处:《福建医科大学学报》2016年第1期31-37,共7页Journal of Fujian Medical University

基  金:国家重点专科建设项目[财社2011(170)];福建省卫生厅创新基金(2009-CXB-1)

摘  要:目的研究镇痛镇静对重型脑损伤患者早期心率变异性(HRV)及血清儿茶酚胺的影响,明确重型脑损伤患者早期使用镇痛镇静剂的安全性及有效性。方法单中心、前瞻性、非随机对照、开放研究。收集起病48h内入住外科重症病房(SICU)的重型脑损伤患者34例为研究对象,其中镇静组15例在入住SICU后即予咪达唑仑及舒芬太尼持续镇痛镇静,非镇静组19例按SICU常规治疗。连续3d监测所有患者同一时间段24h动态心电图;连续4d检测所有患者每天8:00血儿茶酚胺(肾上腺素、去甲肾上腺素)水平。收集同期24例体检者作为对照组。结果镇静组及非镇静组的血清儿茶酚胺的水平与正常参考值比较均升高(P<0.05),非镇静组儿茶酚胺水平较镇静组高,但差别无统计学意义(P>0.05)。镇静组和非镇静组的HRV各指标水平均明显小于对照组(P<0.05)。短期预后评估中镇静组的昏迷天数、总住院时间均明显小于非镇静组(P<0.05)。结论重型脑损伤可引起血清儿茶酚胺升高及自主神经功能紊乱。镇痛镇静可以改善自主神经功能紊乱,减少儿茶酚胺分泌,改善短期预后,但仍需大样本的研究以证实。Objective To study the impact of analgesic and sedative on the heart rate variability(HRV)and plasma catecholamine in severe brain injury patients,to evaluate the safety and efficacy of analgesic and sedative early in severe brain injury patients. Method A prospective,single-center,non-randomized controlled clinical trial was conducted in 34 severe brain injury patients admitted to our Surgical Intensive Care Unit(SICU)within 48 hours of injury. Midazolam and sufentanil were used in the sedated group(n=15)as soon as they were admitted to the SICU. The routine treatments were performed in both sedated group and non-sedated group(n=19). All patients underwent continuous 24 hours Holter monitoring for the same period for 3consecutive days,and blood samples were drawn at 08:00every day to check blood catecholamine levels(epinephrine and norepinephrine)for 4consecutive days. We also collected 24 healthy subjects' HRV indices from the same period,as normal control group. Results After severe brain injury,compared with normal reference values,the serum catecholamine levels in both the sedated group and non-sedated group were significantly increased(P〈0.05);the epinephrine and norepinephrine levels in non-sedated group were higher than the sedated group,but the difference between them was not statistically significant(P〉0.05). The levels of HRV indices in both the sedated group and non-sedated group were significantly less than the normal control group(P〈0.05). The sedated group had shorter coma days and total hospital stay than the non-sedated group(P〈0.05). Conclusion Severe brain injury can lead to plasma catecholamine levels increased and autonomic nervous system dysfunction. Using of the sedative and analgesic drugs can improve short-term prognosis and may improve autonomic nervous system dysfunction,though the study needs to be confirmed with large sample studies.

关 键 词:脑损伤 镇痛 催眠药和镇静药 心率 儿茶酚胺类 交感神经系统 副交感神经系统 

分 类 号:R651.15[医药卫生—外科学]

 

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