瑞芬太尼联合右美托咪定对重症颅脑损伤开颅术后患者的镇静镇痛效果  

Sedation and analgesia effect of remifentanil combined with dexmedetomidine in patients with after craniotomy severe traumatic brain injury

作　　者：王廷海 刘宣 李宏达 王龙 WANG Tinghai;LIU Xuan;LI Hongda;WANG Long(Intensive Care Unit,Beijing Jingxin Hospital,Beijing 100122,China)

机构地区：[1]北京京信医院重症监护室,北京市100122

出　　处：《临床合理用药》2025年第6期14-17,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察瑞芬太尼联合右美托咪定对重症颅脑损伤开颅术后患者的镇静镇痛效果。方法选取2019年10月—2024年6月北京京信医院收治的重症颅脑损伤开颅术后患者118例,采用随机数字表法分为观察组和对照组,各59例。患者术前及术中均采用相同的治疗方案,对照组术后予盐酸右美托咪定注射液镇静镇痛维持,观察组术后在对照组基础上联合注射用盐酸瑞芬太尼镇静镇痛维持。比较2组不同时点Riker镇静—躁动评估量表(SAS)、疼痛数字评定量表(NRS)评分,给药前及给药后12、24 h平均动脉压(MAP)、心率(HR)、实验室相关指标[皮质醇(Cor)、肾上腺素(E)、S100β蛋白、神经元特异性烯醇化酶(NSE)],不良反应。结果给药后2、6、12、24 h,2组SAS、NRS评分均低于给药前,且观察组低于对照组(P<0.01)。给药后12、24 h,2组MAP及HR均低于给药前,且观察组低于对照组(P<0.01);2组Cor、E及NSE水平低于给药前,且观察组Cor、E、S100β蛋白及NSE水平低于对照组(P<0.05或P<0.01)。观察组与对照组不良反应总发生率比较差异无统计学意义(13.56%vs.8.47%,χ^(2)=0.778,P=0.378)。结论瑞芬太尼联合右美托咪定能有效提高重症颅脑损伤开颅术后患者的镇静镇痛效果,可维持血流动力学稳定,有效降低机体应激反应,改善神经功能,且安全性较高。Objective To observe the sedation and analgesia effect of remifentanil combined with dexmedetomidine in patients with severe traumatic brain injury.Methods A total of 118 cases of patients with after craniotomy severe traumatic brain injury admitted to Beijing Jingxin Hospital from October 2019 to June 2024 were selected,and they were divided into the observation group and the control group,with 59 patients in each group.Both groups were received the same treatment protocol before and during surgery.The control group was treated with dexmedetomidine hydrochloride injection postoperatively,while the observation group was treated with remifentanil hydrochloride injection on the basis of the control group.SAS score and NRS score at different time points,MAP,HR,levels of Cor,E,S100βprotein,NSE before medication administration and at 12,24 hours post-medication,incidence of adverse reactions were compared between the two groups.Results At 2,6,12,and 24 hours post-medication,SAS score and NRS score of the two groups were lower than those before medication administration,and those in the observation group were lower than the control group(P<0.01).At 12,24 hours post-medication,MAP and HR of the two groups were lower than those before medication administration,and the observation group were lower than those in the control group(P<0.01);Levels of Cor,E and NSE of the two groups were lower than those before medication administration,and levels of Cor,E,S100βprotein,NSE were lower than those in the control group(P<0.05 or P<0.01).There was no significant difference of incidence of adverse reactions between the observation group and the control group(13.56%vs.8.47%,χ^(2)=0.778,P=0.378).Conclusion The combination of remifentanil and dexmedetomidine can effectively enhance the sedation and analgesia effect for patients with after craniotomy severe traumatic brain injury,which can maintain hemodynamic stability,effectively reduce the body's stress response,improve neurological function,and with higher safety.

关 键 词：重症颅脑损伤 瑞芬太尼 右美托咪定 镇静 镇痛 

分 类 号：R61[医药卫生—外科学]