神经重症监护病房收住创伤性脑损伤患者的指征及早期用药情况调查  

Indication and early medicational administration of patients with traumatic brain injury for admission to neurological intensive care unit

作　　者：郎力键 杨春[1,2] 冯军峰 高国一[2,3] 江基尧 Lang Lijian;Yang Chun;Feng Junfeng;Gao Guoyi;Jiang Jiyao(Brain Injury Center,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Shanghai Institute of Head Trauma,Shanghai 200127,China;Department of Neurosurgery,Shanghai First People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201600,China)

机构地区：[1]上海交通大学医学院附属仁济医院颅脑创伤中心,上海200127 [2]上海市颅脑创伤研究所,上海200127 [3]上海交通大学医学院附属第一人民医院神经外科,上海201600

出　　处：《中华创伤杂志》2022年第9期785-790,共6页Chinese Journal of Trauma

基　　金：上海市优秀学术带头人计划(21XD1422400);上海市医苑新星杰出青年医学人才项目(20224Z0012)。

摘　　要：目的分析神经重症监护病房(NICU)收住创伤性脑损伤(TBI)患者的指征、早期镇痛镇静和抗癫痫药物应用情况。方法采用问卷调查,内容涵盖医院基本特征、院前及急诊救治、住院治疗、神经重症和康复等方面,通过网络或邮件调查中国参与欧洲创伤性脑损伤疗效比较研究(CENTER-TBI)的18个省市37家医院NICU,整理并分析NICU收住TBI患者的指征,早期镇痛镇静药物的使用类别、使用频率,早期抗癫痫药物的使用类别、使用频率和使用指征。结果在收住TBI患者的指征方面,30家(81.1%)和24家(64.9%)NICU将格拉斯哥昏迷评分(GCS)≤8分、TBI术后作为主要指征;而收住GCS 9~12分、GCS 13~15分的患者时,大部分NICU考虑是否合并其他危险因素。在早期使用的镇痛镇静药物方面,13家(35.1%)NICU常规使用(即使用频率70%~100%)芬太尼镇痛,24家(64.9%)NICU和18家(48.6%)NICU常规使用咪达唑仑和α-2受体激动剂镇静。在早期使用的抗癫痫药物方面,35家(94.6%)NICU常规使用丙戊酸钠。而对于抗癫痫药物的使用指征,35家(94.6%)、21家(56.8%)和20家(54.1%)NICU分别在伤后2 h内发作癫痫、贯通性脑损伤、皮质挫伤的情况下常规使用抗癫痫药物。结论重型TBI、TBI术后是NICU主要的收住指征,收住中型、轻型TBI患者时则会考虑是否合并其他危险因素;芬太尼、咪达唑仑和丙戊酸钠分别是NICU收住TBI患者早期最为常用的镇痛、镇静和抗癫痫药物;伤后2 h内发作癫痫、贯通性脑损伤、皮质挫伤则是主要的抗癫痫药物使用指征。Objective To analyze the indication and status of early use of analgesic,sedative and antiepileptic drugs of patients with traumatic brain injury(TBI)admitted to the neurological intensive care unit(NICU).Methods A questionnaire covering hospital basic characteristics,prehospital and emergency care,inpatient treatment,neurocritical care and rehabilitation were used to survey NICU of 37 hospitals in 18 municipalities or provinces from the Chinese registry of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury(CENTERTBI)by Web or Email.The indications for admission to the NICU,categories and frequency of early use of analgesic and sedative drugs,and categories,frequency and indications of early use of antiepileptic drugs were analyzed.Results Glasgow coma scale(GCS)≤8 points in patients with TBI and post-operation of TBI were the main indications for admission in 30 NICU(81.1%)and 24 NICU(64.9%),respectively.When admitting patients with a GCS of 9-12 points or 13-15 points,most NICU gave more considerations to the combined other risk factors.In terms of the early use of analgesics and sedatives,fentanyl was routinely used for analgesia(i.e.,use frequency for 70%-100%)in 13 NICU(35.1%),and midazolam and alpha-2 agonists were routinely used for sedation in 24 NICU(64.9%)and 18 NICU(48.6%),respectively.Regarding the early use of antiepileptic drugs,sodium valproate was routinely used in 35 NICU(94.6%).Moreover,seizures within 2 hours after injury,penetrating TBI and cortical contusion were indications for routine application of antiepileptic drugs in 35 NICU(94.6%),21 NICU(56.8%)and 20 NICU(54.1%),respectively.Conclusions Severe TBI and post-operation of TBI are the main indications for admission to the NICU,while the combination of other risk factors will be considered when admitting patients with moderate or mild TBI.For TBI patients admitted to NICU,fentanyl,midazolam and sodium valproate are the most commonly used analgesic,sedative,and antiepileptic drugs in the early stage.S

关 键 词：脑损伤 创伤性 重症监护病房 镇痛药 癫痫 创伤后 

分 类 号：R969[医药卫生—药理学]