咪达唑仑在创伤性颅脑损伤患者镇静治疗中的应用及影响  

Application and effect of midazolam in sedation treatment of traumatic brain injury

作　　者：赵海康[1] 杨磊[1] 袁致海[1] 王林林 魏尧 陈鹏[1] 王凤鹿 Zhao Haikang;Yang Lei;Yuan Zhihai;Wang Linlin;Wei Yao;Chen Peng;Wang Fenglu(Department of Neurosurgery,the Second Affiliated Hospital of Xi’an Medical University,Xi’an 710038,China)

机构地区：[1]西安医学院第二附属医院神经外科,西安710038

出　　处：《中华脑科疾病与康复杂志（电子版）》2020年第3期165-168,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的 研究静脉注射咪达唑仑对镇静治疗中创伤性颅脑损伤患者的脑血流动力学、呼吸状况及长期预后的影响。 方法 纳入西安医学院第二附属医院神经外科自2014年5月至2019年12月收治的70例创伤性颅脑损伤患者,按照随机数字表法分为治疗组(35例)和对照组(35例)。治疗组患者以0.1 mg/(kg·h)的速度静脉注射咪达唑仑,同时对照组患者不采用任何镇静镇痛剂以及其他影响颅内血流动力学的药物。应用经颅多普勒超声分别测定2组患者的大脑中动脉平均血流速度,以及收集患者收缩压、心率、呼吸频率等参数。 结果 治疗组患者的流速尽管有所降低,但与对照组比差异并无统计学意义(P>0.05)。此外,治疗组心率、收缩压和呼吸频率较对照组均有明显下降,其中呼吸频率的差异具有统计学意义(P=0.049)。进一步分析随访资料发现2组患者的死亡率及GOS评分差异均无统计学意义(P>0.05)。 结论 静脉注射咪达唑仑可有效控制患者躁动,且可在一定程度上影响患者的颅内血流动力学以及呼吸状况,但对创伤性颅脑损伤患者的长期预后并无显著影响。Objective To study the application of intravenous midazolam in sedation treatment of traumatic brain injury and its effect on cerebral hemodynamics,respiratory status and long-term prognosis.Methods Seventy patients with traumatic brain injury admitted to Neurosurgery Department of the Second Affiliated Hospital of Xi’an Medical University from May 2014 to December 2019 were selected and randomly divided into the treatment group(n=35)and the control group(n=35).In the treatment group,midazolam were injected intravenously at a rate of 0.1 mg/(kg·h),while patients in the control group were not given any sedatives or analgesics or other drugs affecting intracranial hemodynamics.Transcranial doppler ultrasonography was used to measure the mean blood flow velocity of the middle cerebral artery,and the parameters such as systolic blood pressure,heart rate and respiratory frequency were collected.Results Although the flow velocity of patients in the treatment group decreased,the difference was not statistically significant between the two groups(P>0.05).In addition,the heart rate,systolic blood pressure and respiratory rate of the treatment group were significantly lower than those of the control group,and the difference in respiratory rate was statistically significant(P=0.049).Further analysis of the follow-up data showed that there was no significant difference in the mortality and GOS between the two groups(P>0.05).Conclusion Intravenous midazolam can effectively control agitation,and can affect the intracranial hemodynamics and respiratory status of patients to a certain extent,but it has no significant impact on the long-term prognosis of patients with traumatic brain injury.

关 键 词：咪达唑仑 颅脑损伤 镇静 经颅多普勒超声 

分 类 号：R651.15[医药卫生—外科学]