右美托咪啶对重型颅脑外伤患者躁动镇静效果及麻醉中脑保护作用的研究  

Study on the sedative effects and the protective effects of dexmedetomidine on middle brain of patients with severe craniocerebral trauma undergoing anesthesia

作　　者：任越[1] 武懿[2] 刘建军[1] 武广义[2] REN Yue;WU Yi;LIU Jianjun(Department of Anesthesiology,The Fifth Hospital of Baoding City,Hebei,Baoding 071000,China)

机构地区：[1]河北省保定市第五医院麻醉科,071000 [2]河北大学附属医院麻醉科,河北省保定市071000

出　　处：《河北医药》2019年第22期3397-3400,共4页Hebei Medical Journal

基　　金：保定市科学技术研究与发展指导计划(编号:16ZF076)

摘　　要：目的探索右美托咪啶对重型颅脑外伤患者躁动镇静的临床效果及手术麻醉中的脑保护作用。方法选取重型颅脑外伤患者100例,随机分为对照组和观察组,每组50例。对照组给予丙泊酚干预,观察组给予丙泊酚及右美托咪啶干预,随后对比2组患者的S-100β水平、血浆神经元特异性烯醇化酶(NSE)水平、颈内静脉球氧饱和度(SjvO 2)含量、动脉-颈内静脉氧含量差(Da-jvO 2)、脑氧摄取率(CERO 2)含量、不良反应发生率、机械通气时间、意识恢复时间、睫毛反射消失时间、睁眼时间以及各时间段的Ramsay镇静评分、VAS评分。结果观察组患者SjvO 2、Da-jvO 2、CERO 2、S-100β水平、血浆NSE水平、机械通气时间、意识恢复时间、睫毛反射消失时间、睁眼时间、不良反应发生率、麻醉后20 min、60 min Ramsay镇静评分VAS评分均优于对照组(P<0.05),同时观察组麻醉后5、20、60 min PAED评分分低于对照组(P<0.05),各时间段的MAP和HR水平值稳定情况优于对照组(P<0.05)。结论对重型颅脑外伤患者实施丙泊酚及右美托咪啶干预效果显著,能够起到更好的脑保护作用,还能够发挥明显镇静、镇痛效果。Objective To investigate the sedative effects and the protective effects of dexmedetomidine on middle brain of patients with severe craniocerebral trauma undergoing anesthesia.Methods A total of 100 patients with severe craniocerebral trauma who were treated in our hospital from September 2016 to September 2017 were randomly divided into control group and observation group,with 50 patients in each group.The patients in control group were given propofol intervention,and the other 50 patients in observation group were given propofol and dexmedetomidine intervention.The serum levels of NSE,S-100 beta,internal jugular venous oxygen saturation(SjvO 2)content,artery and internal jugular vein oxygen content(Da-jvO 2),brain oxygen uptake rate(CERO 2),the incidence rate of adverse reactions,the mechanical ventilation time,consciousness recovery time,eyelash reflex disappearing time,open time and Ramsay sedation scores as well as VAS scores were observed and compared between the two groups.Results The levels of SjvO 2,Da-jvO 2,CERO 2,S-100β,plasma NSE,and mechanical ventilation time,consciousness recovery time,eyeleyelet reflex disappearance time,eye opening time,incidence rate of adverse reactions,Ramsay sedation scores and VAS scores at 20min,60min after anesthesia in observation group were superior to those in control group(P<0.05).Moreover the PAED scores at 5min,20min,60min after anesthesia in observation group were significantly lower than those in control group(P<0.05).In addition the levels of MAP and HR in observation group were superior to those in control group(P<0.05).Conclusion Propofol and dexmedetomidine have significant intervention effects for patients with severe craniocerebral trauma undergoing anesthesia,which have better brain protection effects,sedation effects and analgesia effects.

关 键 词：右美托咪啶 重型颅脑外伤 躁动 镇静 麻醉 脑保护 

分 类 号：R651.15[医药卫生—外科学] R971.2[医药卫生—临床医学]