重型颅脑损伤患者去骨瓣减压术后联合应用亚低温疗法和右美托咪定静脉注射效果观察  

Efficacy of mild hypothermia combined with intravenous injection of dexmedetomidine in patients with severe traumatic brain injury after decompressive craniectomy

作　　者：李灿 张婷[1] 陈钇然 邹帅[1] 杨锦平 余娜 LI Can;ZHANG Ting;CHEN Yiran;ZOU Shuai;YANG Jinping;YU Na(Department of Critical Care Medicine,Chongqing Fifth People's Hospital,Chongqing 400062,China)

机构地区：[1]重庆市第五人民医院重症医学科,重庆400062

出　　处：《山东医药》2025年第2期115-119,共5页Shandong Medical Journal

基　　金：重庆市南岸区科卫联合基金项目(2019-06)。

摘　　要：目的观察重型颅脑损伤(sTBI)患者去骨瓣减压术后联合应用亚低温疗法和右美托咪定静脉注射效果。方法选择96例sTBI患者,根据治疗方案分为观察组48例、对照组48例。两组均行去骨瓣减压术,术后对照组接受亚低温疗法,观察组在对照组的基础上联合右美托咪定[0.4~0.7µg/(kg·h)]静脉注射治疗。分别于术前(T0)、术后1 d(T1)、术后3 d(T2)、术后7 d(T3)采用格拉斯哥昏迷量表(GCS)评分评估两组创伤严重程度,采用脑室外引流装置及彩色多普勒超声系统检测两组颅内压(ICP)、脑灌注压(CPP)及脑血流量(CBF),采集两组颈内静脉球部及桡动脉血并测算脑氧代谢指标颈静脉血氧饱和度(SjvO_(2))、动脉-颈内静脉血氧含量差(AVDO_(2))及脑氧摄取率(CERO_(2)),采集两组外周静脉血并检测血清胶质纤维酸性蛋白(GFAP)。观察两组术后7、30 d死亡及重残情况,记录治疗期间两组心动过缓、低血压、谵妄等不良反应发生情况。结果与T0相比,两组T1、T2、T3时GCS评分均升高,且观察组升高更明显(P均<0.05)。与T0相比,两组T1、T2、T3时ICP降低而CPP及CBF升高,且观察组变化更明显(P均<0.05)。与T0相比,两组T1、T2、T3时SjvO_(2)升高而AVDO_(2)及CERO_(2)降低,且观察组变化更明显(P均<0.05)。与T0相比,两组T1、T2、T3时血清GFAP水平均降低,且观察组降低更明显(P均<0.05)。两组术后不同时间病死率、重残率及不良反应发生情况间差异无统计学意义(P均>0.05)。结论亚低温疗法联合右美托咪定静脉注射用于sTBI患者去骨瓣减压术后可降低患者ICP、改善脑血流和脑氧代谢,降低血清GFAP水平,且安全性较好。Objective To observe the effects of mild hypothermia therapy combined with intravenous injection of dex medetomidine on patients with severe traumatic brain injury(sTBI)after decompressive craniectomy.Methods Ninety patients with sTBI were selected and divided into the observation group(48 cases)and control group(48 cases).Patients in both groups underwent decompressive craniectomy.Postoperatively,the control group received mild hypothermia therapy,while the observation group received additional intravenous injection of dexmedetomidine[0.4-0.7µg/(kg·h)].The Glasgow Coma Scale(GCS)was used to evaluate trauma severity before surgery(T0)and 1(T1),3(T2),and 7(T3)days after surgery.Intracranial pressure(ICP),cerebral perfusion pressure(CPP),and cerebral blood flow(CBF)were measured by external ventricular drainage device and color Doppler ultrasound system.Cerebral oxygen metabolism indica tors,including jugular venous oxygen saturation(SjvO₂),arteriovenous oxygen content difference(AVDO₂),and cerebral oxygen extraction ratio(CERO₂)were calculated.Serum glial fibrillary acidic protein(GFAP)levels were assessed.Mor tality and severe disability rates at 7 and 30 days after surgery,as well as adverse events such as bradycardia,hypoten sion,and delirium were recorded.Results At T1,T2,and T3,GCS scores significantly increased in both groups in comparison with that at T0,with greater improvement in the observation group(all P<0.05);ICP decreased,while CPP and CBF increased significantly in both groups in comparison with those at T0,with more significant changes in the obser vation group(all P<0.05);SjvO₂significantly increased,while AVDO₂and CERO₂significantly decreased in both groups in comparison with those at T0,with more significant changes in the observation group;serum GFAP levels significantly decreased in both groups in comparison with those at T0,with more significant changes in the observation group(all P<0.05).No significant differences were observed in mortality,severe disability rates,or adverse e

关 键 词：亚低温疗法 右美托咪定 重型颅脑创伤 

分 类 号：R969[医药卫生—药理学]