丙泊酚镇静对颅脑外伤患者术后再出血及预后的影响  

Effects of propofol sedation on rebleeding and prognosis after operation in patients with traumatic brain injury

作　　者：罗孝全 何家全[1] 陈兵 付安辉 冯浩 唐辉[1] LUO Xiaoquan;HE Jiaquan;CHEN Bing;FU Anhui;FENG Hao;TANG Hui(Department of Neurosurgery , The Second Clinical College of North Sichuan Medical College, Nanchong Central Hospital Nanchong 637000, Sichuan, Chin)

机构地区：[1]川北医学院第二临床医学院.南充市中心医院神经外科,四川南充637000

出　　处：《西部医学》2018年第6期847-850,共4页Medical Journal of West China

摘　　要：目的探讨丙泊酚镇静对颅脑外伤患者术后再出血及临床预后的影响。方法收集我院2015年2月~2017年1月收治的颅脑外伤患者131例,按照治疗方法不同分为对照组(62例)和观察组(69例),对其临床资料进行回顾性分析。对照组术后予以常规治疗,观察组在对照组基础上加用丙泊酚镇静治疗,观察两组患者术后Riker镇静躁动评分(Sedation-Agitation Scale,SAS)、颅内压(Intracranial pressure,ICP)、心率(Heart rate,HR)、收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、血氧饱和度(SpO2)等指标,行组间差异性分析,比较两组患者术后再出血率、病死率及术后6个月时格拉斯哥预后评分(Glasgow Outcome Scale,GOS)。结果观察组患者SAS、ICP在术后1、2、4、8h各个时间点均低于对照组,差异有统计学意义(P<0.05);两组患者的HR、SBP、DBP在术后1h差异无统计学意义(P>0.05),但在术后2、4、8h差异有统计学意义(P<0.05);观察组再出血率明显低于对照组,差异有统计学意义(P<0.05);观察组病死率低于对照组,但差异无统计学意义(P>0.05);术后六个月时格拉斯哥预后评分观察组与对照组比较,差异有统计学意义(P<0.05)。结论颅脑外伤患者术后使用丙泊酚镇静能避免剧烈躁动,减少再出血发生率,改善患者远期预后,提高生存质量。Objective To investigate the effect of postoperative propofol sedation on rebleeding and clinical prognosis in patients with traumatic brain injury. Methods The clinical data of 131 patients with traumatic brain injury included in the February 2015 to January 2017 were collected and analyzed retrospectively. Results The levels of sedation-agitation scale （SAS） and intracranial pressure （ICP） in the observation group were lower than those in the control group at 1 h, 2 h, 4 h and 8 h after operation, with statistical significance （P〈0.05）. There were no significant differences in heart rate （HR）, systolic blood pressure （SBP） and diastolic blood pressure（DBP） between the two groups at 1 h after operation （P〈 0.05）, but there was significant difference between the two groups at 2 h, 4 h and 8 h after operation （P〈 0.05）. The rate of rebleeding in the observation group（7.25%） was lower than that in the control group （19.35%）, with statistical significance （P〈0.05）. The mortality rate in the observation group （8.70%） was lower than that in the control group （14.52 %）, with no statistically significant （P〉0.05）. The glasgow outcome scale （GOS） of the observation group was better than that of the control group at 6 months after operation, with statistical significance （P〈0.05）. Conclusion Postoperative sedation in patients with traumatic brain injury can avoid severe restlessness, reduce the incidence of rebleeding, and improve long-term prognosis with better quality of life.

关 键 词：颅脑外伤 丙泊酚镇静 术后再出血 预后 

分 类 号：R651.15[医药卫生—外科学]