地佐辛联合右美托咪定在颅脑外伤患者镇痛镇静中的应用效果  

Application Effect of Dezocine combined with Dexmedetomidine on Anal⁃gesia and Sedation in Patients with Craniocerebral Trauma

作　　者：李芳[1] LI Fang(Department of Critical Care Medicine,Kunshan Hospital of Traditional Chinese Medicine,Kunshan,Jiangsu Province,215300 China)

机构地区：[1]昆山市中医医院重症医学科,江苏昆山215300

出　　处：《中外医疗》2023年第1期131-135,共5页China & Foreign Medical Treatment

摘　　要：目的研究地佐辛联合右美托咪定在颅脑外伤患者镇痛镇静中的应用效果。方法随机选取2021年1月—2022年1月昆山市中医医院的100例ICU颅脑外伤患者,按照不同治疗方法分成对照组和观察组,每组50例。对照组联合应用咪达唑仑注射液、地佐辛,观察组联合应用右美托咪定、地佐辛。利用视觉模拟评分(VAS)对比两组术后3 h(T3)、6 h(T4)、12 h(T5)、24 h(T6)的镇痛效果;观察患者采取镇静方案后的机械通气时间、停药后自醒时间、平均住入ICU时间、平均住院费用、镇静评分(RASS);比较两组患者在麻醉前(T1)、手术结束时(T2)、术后24 h(T6)、术后48 h(T7)的免疫指标;运用谵妄评估量表(CAM-ICU)比较两组的谵妄发生情况以及不良反应情况。结果两组术后VAS评分均呈现逐渐下降趋势,观察组T4、T5、T6的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组机械通气时间、停药后自醒时间和平均住入ICU时间明显缩短,平均住院费用减少,RASS镇静评分优于对照组,差异有统计学意义(P<0.05)。两组T2、T6、T7的CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均比T1低,并且观察组术后48 h以上免疫指标均高于对照组,另外NK细胞活性低于对照组,差异有统计学意义(P<0.05)。观察组的谵妄发生率(8.00%)和总不良反应率(12.00%)明显低于对照组(24.00%、30.00%),差异有统计学意义(χ^(2)=4.762、4.882,P<0.05)。结论右美托咪定联合地佐辛镇痛方案更优,镇痛效果显著,对免疫功能影响小,有利于神经功能的恢复。Objective To study the effect of dezocine combined with dexmedetomidine on analgesia and sedation in patients with craniocerebral trauma.Methods Randomly selected 100 ICU craniocerebral injury patients from Kun⁃shan Traditional Chinese Medicine Hospital from January 2021 to January 2022,and divided them into a control group and an observation group according to different treatment methods,with 50 cases in each group.The control group received a combination of midazolam injection and dexamethasone,while the observation group received a com⁃bination of dexmedetomidine and dexamethasone.Compared the analgesic effects of two groups at 3 hours(T3),6 hours(T4),12 hours(T5),and 24 hours(T6)after surgery using Visual Analog Scale(VAS);observed the mechanical ventilation time,self awakening time after stopping medication,average time to stay in the ICU,average hospitaliza⁃tion cost,and sedation score(RASS)of the patient after adopting a sedation plan;compared the immune indicators of two groups of patients before anesthesia(T1),at the end of surgery(T2),24 hours after surgery(T6),and 48 hours after surgery(T7);compared the incidence of delirium and adverse reactions between the two groups using the Delirium As⁃sessment Scale(CAM-ICU).Results The postoperative VAS scores of both groups showed a gradually decreasing trend,the VAS scores of T4,T5,and T6 in the observation group were lower than those in the control group,the differ⁃ence was statistically significant(P<0.05).The observation group showed a significant reduction in mechanical ventila⁃tion time,self awakening time after discontinuation of medication,and average time to stay in the ICU.The average hospitalization cost decreased,and the RASS sedation score was better than the control group,the difference was statistically significant(P<0.05).The CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)levels of T2,T6,and T7 in the two groups were lower than those in T1,and the above immune indicators in the observation group were higher than those in the control group 48

关 键 词：镇痛 咪达唑仑注射液 地佐辛 联合用药 右美托咪定 神经功能 免疫功能 

分 类 号：R5[医药卫生—内科学]