右美托咪定与咪唑安定对重型颅脑外伤患者围术期炎症反应及颅内压的影响

Effects of Dexmedetomidine or Midazolam on inflammatory response and ICP of patients with severe traumatic brain injuries during perioperative period

目的探讨右美托咪定与咪唑安定对重型颅脑外伤患者围术期的疗效比较。方法将90例重型颅脑伤患者随机分为对照组、咪唑安定组、右美托咪定组,每组30例。右美托咪定组在手术开始前30 min以0.8μg/kg微泵10 min静脉注射,后持续静脉泵注0.2μg/（kg·h）维持至术毕24 h。咪唑安定组在麻醉诱导时静注咪唑安定0.1 mg/kg,患者回ICU后持续泵注30μg/（kg·h）至术毕24 h。对照组按照右美托咪定的泵注方法给予相同容量的生理盐水。3组患者均采用全凭静脉麻醉,分别于麻醉诱导前、术毕、术后24 h和术后48 h（T1～T4）抽血测定血清中白介素-6（IL-6）、白介素-10（IL-10）和肿瘤坏死因子-α（TNF-α）水平,并记录患者术后6、12、24、36和48 h的Riker镇静躁动评分,以及各时点相应的ICP数值。结果右美托咪定组术毕、术后24 h和术后48 h的TNF-α和IL-6水平较对照组和咪唑安定组明显降低（P〈0.05）;而相同时点的IL-10水平则高于对照组和咪唑安定组（P〈0.05）。右美托咪定组和咪唑安定组术后24 h内的镇静躁动评分以及颅内压控制水平均好于对照组（P〈0.01）,但术后6 h及术后24 h咪唑安定组的镇静深度要高于右美托咪定组（P〈0.05）。结论相对咪唑安定而言,右美托咪定不影响术后对患者意识水平的判断,有助于减轻重型颅脑伤患者围手术期的炎症反应,降低患者颅内压水平,具有一定脑保护作用,有利于改善患者预后。

【Objective】 To investigate the efficacy comparison between Dexmedetomidine and Midazolam in the treatment of patients with severe traumatic brain injuries during perioperative period. 【Methods】 90 patients with severe traumatic brain injuries were randomly divided into the control group, the DEX group and the Midazolam group（each group, n =30）. In the DEX group, Dexmedetomidine 0.8 μg/kg was infused by continuous intravenous pumping for 10 mins at 30 mins before the operation started, and 0.2 μg/（kg·h） maintained until the following 24 hours after the surgery was completed. Midazolam was given 0.1 mg/kg by intravenous injection to patients of the Midazolam group at the beginning of anesthetization, and 30 μg/（kg·h）maintained in ICU until the following 24 hours after the surgery was completed. According to the method of the DEX group, the same amount of saline was given to the control group. The operations of the three groups were conducted using total intravenous anesthesia. The blood was drawn before anesthesia, at the end of surgery, 24 hours after the operation, and 48 hours after the operation, respectively. The serum tumor necrosis factor-ɑ（TNF-α）, interleukin-6（IL-6） and interleukin-10（IL-10） levels were detected accordingly. Riker Sedation-Agitation Scale（SAS） and ICP were recorded within 6 hours, 12 hours, 24 hours, 36 hours and 48 hours after the operation. 【Results】 Compared to the control group and the Midazolam group, there was a significant decline in the levels of TNF-ɑ and IL-6 in the DEX group at the end of surgery, 24 hours and48 hours after the operation（P〈0.05）. On the contrary, the level of IL-10 was lower than that was in the other groups（P〈0.05）. During the 24 hours after the operation, the SAS and ICP of the DEX group and the Midazolam group were better than that were in the control group（P〈0.01）. In the 6 hours and 24 hours after the operation, the level of sedation in the Midazolam group was higher than the DEX group（P〈0.05）.【Conclusion】 Dexmedetomidine does not affect the estimate to the patients after the surgery compare with Midazolam, which can relieve the likelihood of inflammation of the patients with severe traumatic brain injuries during the perioperative period and reduce the level of ICP. Furthermore, it protects the patient＇s brain and improves the prognosis of the patients.