丙泊酚靶控输注联合右美托咪定对颅脑外伤患者脑状态指数、意识及预后影响  

Effects of propofol target-controlled infusion combined with dexmedetomidine on cerebral state index,consciousness and prognosis in patients with craniocerebral trauma

作　　者：袁茂 张秦旺 魏钱碧 叶晓莉 YUAN Mao;ZHANG Qin-wang;WEI Qian-bi;YE Xiao-li(Department of Anesthesia Surgery,The First People’s Hospital of Shuangliu District,Chengdu 610200,China)

机构地区：[1]成都市双流区第一人民医院麻醉手术部,四川成都610200 [2]长治医学院附属和平医院疼痛科,山西长治046000 [3]西藏自治区人民政府驻成都办事处医院麻醉科,四川成都610041

出　　处：《创伤与急危重病医学》2023年第3期177-180,185,共5页Trauma and Critical Care Medicine

基　　金：四川省卫生计生委科研课题(16PJ374)。

摘　　要：目的探讨丙泊酚靶控输注联合右美托咪定对颅脑外伤患者脑状态指数(CSI)、意识及预后的影响。方法选取自2020年1月至2022年1月收治的100例颅脑外伤患者为研究对象。根据随机数字表法将患者分为A组和B组,每组各50例。两组均行颅内血肿清除术治疗,麻醉诱导后A组患者给予丙泊酚靶控输注维持麻醉,B组患者给予丙泊酚靶控输注联合右美托咪定维持麻醉,比较两组患者CSI、应激反应指标、苏醒质量、苏醒后不同时刻[麻醉诱导前(T0)、气管插管时(T1)、切皮时(T2)、血肿清除时(T3)、术毕时(T4)]意识状态,并记录两组患者认知功能障碍的发生情况。结果两组患者T2、T3、T4时的血清去甲肾上腺素(NE)、皮质醇(Cor)水平均高于T0、T1时,但B组患者NE、Cor水平均低于A组,差异有统计学意义(P<0.05)。两组患者T1、T2、T3、T4时的CSI均较T0时降低,且B组患者T2、T3、T4时的CSI均低于A组,差异有统计学意义(P<0.05)。A组患者T2、T3、T4时的CSI均高于T1时,差异有统计学意义(P<0.05)。B组患者的苏醒时间、听指令睁眼时间、滞留苏醒室时间均短于A组,差异有统计学意义(P<0.05)。B组患者苏醒后0.5、1.0、3.0、6.0 h的格拉斯哥昏迷量表评分均高于A组,差异有统计学意义(P<0.05)。出院时,两组患者的认知功能障碍发生情况比较,差异无统计学意义(P>0.05)。结论丙泊酚靶控输注联合右美托咪定可有效抑制颅脑外伤患者的应激反应,促进术后苏醒,改善脑状态及苏醒后意识状态,且对认知功能无明显不良影响,具有一定安全性。Objective To investigate the effect of propofol target-controlled infusion combined with dexmedetomidine on cerebral state index(CSI),consciousness and prognosis in patients with craniocerebral trauma.Methods A total of 100 patients with craniocerebral trauma from January 2020 to January 2022 were selected and randomly divided into the group A and the group B,with 50 cases in each group.Both groups were treated with intracranial hematoma evacuation.After induction of anesthesia,the A group was given propofol target-controlled infusion to maintain anesthesia,and the group A was given propofol target-controlled infusion combined with dexmedetomidine to maintain anesthesia.The CSI,stress response indicators,awakening quality,and conscious states at different times after recovery[before anesthesia induction(T0),tracheal intubation(T1),cuticle resection(T2),hematoma clearance(T3),and surgery(T4)]were compared between the two groups,and the incidence of cognitive dysfunction in the two groups was also counted.Results Serum norepinephrine(NE)and cortisol(Cor)levels in 2 groups at T2,T3 and T4 were higher than those at T0 and T1,but NE and Cor levels in group B were lower than those in group A,the difference was statistically significant(P<0.05).CSI at T1,T2,T3 and T4 in 2 groups was lower than that at T0,and CSI at T2,T3 and T4 in group B was lower than that in group A,the difference was statistically significant(P<0.05).The CSI of group A at T2,T3 and T4 was higher than that at T1,the difference was statistically significant(P<0.05).The recovery time,eye opening time upon instruction and retention time in the recovery room of group B were shorter than those of group A,and the differences were statistically significant(P<0.05).Glasgow coma scale scores of 0.5,1.0,3.0 and 6.0 h after recovery in group B were higher than those in group A,and the difference was statistically significant(P<0.05).At discharge,there was no statistical significance in the occurrence of cognitive dysfunction between the two groups(P>0.05).Concl

关 键 词：颅脑外伤 脑状态指数 丙泊酚 右美托咪定 认知功能 意识状态 

分 类 号：R614[医药卫生—麻醉学]