咪达唑仑对重症脑损伤患者脑代谢影响的临床研究

Effect of Midazolam on Cerebral Metabolism in the Treatment of Severe Trauma

目的探讨咪达唑仑对重症脑损伤患者脑代谢的影响。方法选取因外伤导致的严重脑损伤患者80例,随机分为对照组40例,予临床常规基础治疗外,加用枸缘酸芬太尼注射液、丙泊酚注射液和右美托咪定治疗;研究组40例,予常规基础治疗外,加枸缘酸芬太尼注射液、丙泊酚注射液和咪达唑仑注射液治疗。观察两组患者治疗前后心率、平均动脉压、动脉血氧分压(PaO_2)、静脉血氧分压(PjvO_2)、颈静脉血氧饱和度(SjVO_2)、颈内动脉-静脉血氧分压差(Da-jvO_2)、脑氧代谢率(CERO_2)、血清S-100β蛋白和神经元特异性烯醇化酶(NSE)水平变化。结果 (1)与治疗前比较,治疗后对照组患者心率降低[(82.35±9.72)次/分比(102.27±12.01)次/分],平均动脉压降低[(165.15±20.52)mm/Hg比(182.35±21.73)mm/Hg],Da-jvO_2降低[(2.51±0.71)CB/mmol/L比(2.78±0.41)CB/mmol/L],CERO_2降低[(0.15±0.04)%比(0.17±0.02)%],血清S-100β蛋白降低[(4.66±1.32)μg/L比(6.18±1.71)μg/L],NSE水平降低[(16.13±2.14)μg/L比(24.17±3.02)μg/L],PaO_2升高[(20.26±3.25)p/k Pa比(9.57±1.18)p/k Pa],PjvO_2升高[(4.14±0.66)p/k Pa比(3.46±0.53)p/k Pa],SjVO_2升高[(50.23±7.24)%比(45.35±6.15)%],以上结果差异均有统计学意义(P<0.05)。(2)与对照组治疗后比较,研究组患者心率(71.21±10.04)次/分、平均动脉压(141.90±15.33)mm/Hg、Da-jvO_2(2.25±0.38)CB/mmol/L、CERO_2(0.12±0.05)%、血清S-100β蛋白(3.21±1.20)μg/L、NSE水平(10.12±4.15)μg/L均显著降低,差异均有统计学意义(P<0.05);动脉血氧分压PaO_2(25.21±3.01)p/k Pa、PjvO_2(4.52±0.61)p/kPa、SjVO_2(65.21±8.13)%均显著升高,差异均有统计学意义(P<0.05)。结论咪达唑仑能有效降低重症脑损伤患者脑代谢水平。

Objective To investigate the effect of midazolam on cerebral metabolismin in patients with severe trauma. Methods Eighty patients with severe brain trauma from 12. 2014 to12. 2015 in our hospital were selected and randomly divided into 2 groups： 40 patients in the control group received clinical conventional treatment, fentanyl citrate injection, propofol injection and dexmedetomidine, the rest 40 patients in the experiment group received fentanyl citrate injection, propofol injection, and midazolam injection in addition to conventional treatment.The heart rate, mean arterial pressure, PaO_2, PjvO_2, SjVO_2, Da-jvO_2, CERO_2, levels of serum S-100β and neuron specific enolase（NSE） were compared before and after treatment in two groups. Results Compared with those parameters before treatment, the heart rate, mean arterial pressure, Da-jvO_2, serum CERO_2, S-100β and NSE protein in two groups decreased after treatment [（82.35±9.72）beats/min vs（102.27±12.01）beats/min;（165.15±20.52）mm Hg vs（182.35±21.73）mm Hg;（2.51±0.71）CB/mmol/L vs（2.78±0.41）CB/mmol/L;（0.15±0.04）% vs（0.17±0.02）%;（4.66±1.32）μg/L vs（6.18±1.71）μg/L;（16.13±2.14）μg/L vs（24.17±3.02）μg/L; allP〈0.05], and the levels of PaO_2, PjvO_2 and SjVO_2increased[（20.26±3.25）p/k Pa vs（9.57±1.18）p/k Pa;（4.14±0.66）p/k Pa vs（3.46±0.3）p/k Pa;（50.23±7.24）% vs（45.35±6.15）%; allP〈0.05], respectively. Compared with the control group after treatment, the heart rate（71.21 ±10.04）beats/min, mean arterial pressure（141.90 ±15.33）mm Hg, Da-jvO_2（2.25±0.38）CB/mmol/L,serum CERO_2（0.12±0.05）%, S-100β（3.21±1.20）μg/L and NSE protein（10.12±4.15）μg/L in the experiment group were lower, levels of PaO_2（25.21±3.01）p/k Pa, PjvO_2（4.52±0.61）p/k Pa and SjVO_2（65.21±8.13）% were higher, all with significant differences（P〈0.05）. Conclusion Midazolam can effectively reduce the level of cerebral metabolism in patients with severe traumatic injury.