脑损伤患者躁动的原因及镇静镇痛研究

Study on cause for dysphoria and treatment methods for analgesia and sedation in craniocerebral injury patients

目的探讨颅脑损伤患者躁动的原因及控制躁动的药物和方法。方法首先对颅脑损伤患者躁动分型及原因分析,再静脉注射负荷量曲马多1mg/kg,氟哌利多0.05mg/kg,咪唑安定0.1mg/kg。续接镇痛泵内配制的曲马多合剂曲马多15mg/kg、氟哌利多0.15mg/kg、咪唑安定0.4mg/kg,10g/L普鲁卡因加至100ml,一个镇痛泵可持续静脉输注50h(1.5～2.5ml/h),本组用药时间为40～160h。结果71例躁动患者,Ⅰ、Ⅱ级43例躁动完全控制,患者安静;Ⅲ级19例(其中8例追加了负荷量)躁动基本控制;Ⅳ级1例控制,8例减为Ⅱ级(需追加负荷量)。躁动控制良好63例(89%),较好8例(11%),有效率100%。患者血压、心率、呼吸平稳,不影响脑氧输送,有利于降低颅内压。结论颅脑损伤患者躁动原因为疼痛刺激及急性精神障碍。用镇痛泵持续静脉输注曲马多合剂,血药浓度恒定;患者安静,效果确切;不影响清醒过程,无不良反应;且管理方使,节省人力。是一种比较理想的镇痛、镇静方法。

Objective To study the causes for dysphoria and discuss the medication methods of controlling the dysphoria in cranioeerebral injury patients. Methods First, craniocerebral injury patients were grouped to analyze the causes for their dyshoria. Then, the patients were injected with Tramadol （ 1 mg/kg）, Droperidol （0.05 mg/kg） and Midazolam （0. 1 mg/kg）. Successively, analgestic pump containing combined Tramadol that included Tramadol （15 mg/kg） , Droperidol （0.15 mg/kg） , Midazolam （0.4 mg/kg） and 100 ml 10 g/L Procaine was used for 50 hours, （ 1.5-2, 5） ml/h, continuously. The medication time ranged from 40 hours to 160 hours. Results Of 71 patients with dysphoria, 43 patients with grades I and ]I dysphoria were under complete control, 19 with grade m dysphoria （ eight were injected with more load） under basic control, one with grade Ⅳ dysphoria under control and eight degraded to grade Ⅱ dysphoria but needed additional load. Of all, 63 patients were successfully controlled （89%） and eight （ 11% ） got better, with effectiveness rate of 100%. Blood pressure, heart rate and breath remained clam, which was good for oxygen transferring to brain and reducing of encephalic pressure. Conclusions The causes for dysphoria in craniocerebral injury patients include stimulation of pain and acute psychopathic impediment. Continuous injection of Tramadol via analgesic pump is an ideal medication methhod for analgesia and sedation, for it can not only hold blood and medicament in invariableness, but also make the patients quiet, without bad reaction or affecting process of regaining consciousness.