重症颅脑损伤患者不同气管插管方案的临床对比分析

Comparative analysis of different tracheal intubation in patients with severe brain injury

目的：研究重症颅脑损伤患者不同气管插管方案的临床疗效。方法将82例重症颅脑损伤患者按以数字表法随机分观察组及对照组各41例。观察组患者在右美托咪定诱导结合表面麻醉的基础上行气管插管，而对照组则进行传统气管插管，比较两组效果。结果观察组插管时间为（26．7±13．8）s，显著短于对照组的（41．6±17．9）s（t ＝4．221，P ＝0．000）。插管前两组心血管反应指标差异均无统计学意义（t ＝0．122，P ＝0．903；t ＝0．296，P ＝0．768；t ＝1．128，P ＝0．263），分别插管10 min 后观察组 HR、MAP 水平均显著低于对照组（t ＝3．326，P ＝0．0．001；t ＝2．354，P ＝0．021）。观察组 HR、MAP 插管后低于插管前（t ＝2．548， P ＝0．013；t ＝3．626，P ＝0．000），两组 SpO2高于插管前（t ＝30．622，P ＝0．000；t ＝38．797，P ＝0．000），对照组的 HR 和 MAP 在插管前后差异均无统计学意义（t ＝0．846，P ＝0．400；t ＝1．824，P ＝0．072）。插管前两组对比差异均无统计学意义（t ＝0．183，P ＝0．856；t ＝0．000，P ＝1．000；t ＝1．132，P ＝0．261），分别插管12 h 后观察组 CK-MB、cTnT、BNP 均显著低于对照组（t ＝2．030，P ＝0．046；t ＝2．264，P ＝0．026；t ＝3．785，P ＝0．000）。两组插管后 CK-MB、cTnT、BNP 均显著低于对照组（t ＝7．845，P ＝0．000；t ＝8．591，P ＝0．000；t ＝22．757，P ＝0．000；t ＝5．525，P ＝0．000；t ＝2．264，P ＝0．000；t ＝22．149，P ＝0．000）。观察组 BCS 和 SS 评分均显著高于对照组（t ＝5．739，P ＝0．000；t ＝5．264，P ＝0．000）。结论在右美托咪定诱导结合表面麻醉的基础上行气管插管方案效果显著，安全性较好，值得临床推广应用。

Objective To study the clinical effect of different tracheal intubation in patients with severe brain injury.Methods 82 patients with severe brain injury were selected and randomly divided into observation group and control group,each group had 41 cases.The observation group was given the dexmedetomidine induction combined with surface anesthesia on the basis of endotracheal intubation,and the control group was given traditional endotracheal intubation.The effects of the two groups were compared.Results The intubation time of the observation group was （26.7 ±13.8）s,which was significantly lower than （41.6 ±17.9）s of the control group（t =4.221,P =0.000）.There were no differences in cardiovascular response indices between the two groups before intubation（t =0.122,P =0.903;t =0.296,P =0.768;t =1.128,P =0.263）.After 10min,HR and MAP levels were significantly lower in the observation group than those in the control group（t =3.326,P =0.0.001;t =2.354,P =0.021）.In the observation group,HR,MAP after intubation were lower than before intubation（t =2.548,P =0.013;t =3.626,P =0.000）,the SpO2 of the two groups was higher than that before intubation（t =30.622,P =0.000;t =38.797,P =0.000）,there were no differences in HR and MAP before and after intubation in the control group（t =0.846,P =0.400;t =1.824,P =0.072）.There were no differences between the two groups before intubation（t =0.183,P =0.856;t =0.000,P =1.000;t =1.132,P =0.261）,CK -MB,cTnT,BNP were significantly lower than those in the control group after 12h,respectively（t =2.030,P =0.046;t =2.264,P =0.026;t =3.785,P =0.000）.CK -MB, cTnT,BNP were significantly lower than the control group after intubation in the two groups（t =7.845,P =0.000;t =8.591,P =0.000;t =22.757,P =0.000;t =5.525,P =0.000;t =2.264,P =0.000;t =22.149,P =0.000）.The BCS and SS scores in the observation group were significantly higher than those in the control group（t =5.739,P =0.000;t =5.264,P =0.000）.Conclusion The dexmedetomidine induction combined with topical anesthesia based uplink tracheal intubation scheme has significant effect,safety is good,it is worth of clinical application.