深镇静在重型颅脑损伤患者治疗中的临床价值研究  

The clinical value of deep sedation in the treatment of severe craniocerebral injury

作　　者：李奕冉[1] 孙玉明[1] 俞卫锋[1] 宋金超[1] LI Yi-ran SUN Yu-ming YU Wei-feng et al.(Department of Anesthesia ＆ Intensive Care, Eastern Hepatobiliary Surgery Hospital, Shanghai 201805, China)

机构地区：[1]第二军医大学第三附属医院(东方肝胆外科医院)重症监护室,上海201805

出　　处：《中华全科医学》2017年第9期1463-1465,共3页Chinese Journal of General Practice

基　　金：国家自然科学基金面上项目(81371511)

摘　　要：目的研究深镇静对重型颅脑损伤患者术后应用的有效性。方法选取东方肝胆外科医院2013年6月—2016年6月常规治疗联合深镇静(BIS:20~40)治疗的37例重度颅脑损伤患者为试验组,而同时期未行深镇静(BIS:40~60)治疗的41例重度颅脑损伤患者为对照组。2组患者均采用镇静镇痛、容量管理、机械通气、营养支持等治疗措施。治疗期间严密监测患者的生命体征,当出现血压明显下降、氧饱和度降低,调整镇静药物泵入剂量及呼吸机参数。根据血气结果观察2组患者的颈静脉氧饱和度(Sjv O_2)、动脉-颈静脉氧含量差(AVDO_2)、脑氧摄取率(CEO_2)指标。采用床旁彩超高频线阵探头测量2组患者视神经鞘直径(ONSD)值。采用低频微凸阵探头测量2组患者大脑中动脉的舒张末期流速(Vd)和脉动指数(PI)。比较2组治疗效果。结果试验组治疗第7天平均ONSD值(4.98±0.09)显著低于对照组(5.95±0.05),差异具有统计学意义(P<0.01)。试验组治疗第7天Vd升高、PI下降,与对照组相比,差异具有统计学意义(P<0.01)。试验组治疗第7天Sjv O_2上升、AVDO_2下降、CEO_2下降,与对照组相比,差异具有统计学意义(P<0.01)。结论深镇静降低重度颅脑损伤颅内压、改善脑氧代谢,值得在临床推广使用。Objective To study the effect of deep sedation on severe craniocerebral injury patients after operation. Meth- ods Thirty-seven patients with severe traumatic brain injury from June,2013 to June,2016 were treated with routine treatment and deep sedation（ BIS ：20 -40）. At the same time 41 patients with severe traumatic brain injury who were not treated by deep sedation（ BIS：40 -60）were the control group. Two groups of patients had sedative and analgesia treat- ment, capacity management, mechanical ventilation, nutritional support and other treatment measures. Blood samples were taken to observe the SiO2, AVDO2 and CEO2 indexes of the two groups. The ONSD values of the two groups were measured by bedside color high frequency linear array probe. The diastolic Vd and PI of the middle cerebral artery of the two groups were measured by low frequency micro-convex array probe. We compared the two groups of treatment. Results The mean ONSD （4.98 ± 0. 09 ） was significantly lower in the experimental group than that in the control group （5.95 ± 0.05 ） at the 7th day. The difference was statistically significant （P 〈 0.01 ）. In the experimental group, Vd increased and PI decreased at the 7th day. Compared with the control group, the difference was statistically significant（ P 〈 0.01 ）. In the experimental group,SjvO2 increased,but AVD02 and CEO2 decreased at the 7th day. Compared with the control group, the difference was statistically significant（P 〈 0.01 ）. Conclusion Deep sedation in severe traumatic brain injury can decrease in- tracranial pressure and improve cerebral oxygen metabolism, which is worth popularizing in clinic.

关 键 词：深镇静 重型颅脑损伤 治疗 

分 类 号：R651.15[医药卫生—外科学]