右美托咪定对重型颅脑损伤患者术后持续镇静的效果及脑组织的保护作用  

Continuous Sedation and Brain Protective Effect of Dexmedetomidine on Severe Craniocerebral Injury Patients after Operation

作　　者：凌文娟[1] 沈志强[1] 曹冰[1] 黄志强[1] 张英[1] 付丽 

机构地区：[1]常熟市第二人民医院麻醉科,江苏常熟215500 [2]南京医科大学第一附属医院麻醉科,江苏南京210006

出　　处：《现代生物医学进展》2016年第18期3533-3536,共4页Progress in Modern Biomedicine

基　　金：江苏省自然科学基金项目(BK2012778)

摘　　要：目的：探讨右美托咪定对重型颅脑损伤患者术后持续镇静的效果及脑组织的保护作用。方法：将2013年7月至2015年7月医院收治的90例重度颅脑损伤患者按照随机数字表法分为观察组45例和对照组45例,两组患者均常规麻醉后行开颅手术,观察组术后持续输注右美托咪定,对照组术后持续输注芬太尼。比较两组患者手术不同时间点血清S-100β蛋白、MAP、PCO2、Sp O2、HR及脑氧代谢指标变化情况。结果：两组患者术后各时段Sjv O2、Ca-jv DO2、CERO2比较差异无统计学意义,术后各时段两组间Sjv O2、Ca-jv DO2、CERO2比较差异亦无统计学意义（P〉0.05）。观察组T1-T4时段MAP、HR均显著降低,与T0时段比较比较差异具有统计学意义（P〈0.05）;T1-T4时段观察组MAP、HR显著低于同时段对照组（P〈0.05）。从T1-T4时段两组患者血清S-100β均呈上升趋势,两组T1-T4时段血清S-100β显著高于T0时段（P〈0.05）;T2-T4时段观察组血清S-100β显著低于同时段对照组（P〈0.05）。结论：术后持续输注右美托咪定能够对重度颅脑损伤患者能够对患者产生镇静、镇痛作用,且在一定程度上保护了脑组织。Objective： To explore the continuous sedation and brain protective effect of dexmedetomidine severe craniocerebral injury patients after operation. Methods： A total of 90 cases of severe craniocerebral injury patients treated in hospital from July 2013 to July 2015 were randomly divided into observation group 45 cases and control group 45 cases, patients in the control group were given fentanyl general anesthesia, while the patients in the observation group were given Dex anesthesia. The changes of S-100β protein, MAP,PCO2, Sp O2, HR and cerebral oxygen metabolism indexes at different time points were compared. Results： There were no significant differences in Ca-jv DO2, CERO2 and Sjv O2 between the two groups before and after operation（P〈0.05）. From T1-T4, the MAP and HR significantly decreased in observation group, and compared with T0 the difference with statistically significant（P〈0.05）, and the MAP and HR in observation group were significantly lower than those in the control group in same period（P〈0.05）. From T1-T4, serum S-100βincreased in the two groups, which was significantly higher than that of T0（P〈0.05）, and the observation group was significantly lower than that of the control group in same period（P〈0.05）. Conclusion： Postoperative continuous intravenous infusion of dexmedetomidine had sedative and analgesic effects for severe craniocerebral injury patients, and in a certain extent protected the brain tissue.

关 键 词：右美托咪定 颅脑损伤 镇静 脑组织保护 脑氧代谢 

分 类 号：R651.1[医药卫生—外科学] R614[医药卫生—临床医学]