右美托咪定在重型颅脑损伤患者中的应用及护理

Application and nursing of dexmedetomidine in the patients with severe craniocerebral injury

目的分析右美托咪定在重型颅脑损伤患者中的应用效果,总结相关护理对策。方法回顾性分析应用右美托咪定进行镇静、镇痛治疗的63例重型颅脑损伤患者的临床资料,观察使用过程中患者呼吸、心率、血压及末梢氧饱和度波动情况。结果使用右美托咪定后,患者躁动症状明显好转;使用有创呼吸机患者必要时联合小剂量咪达唑仑或丙泊酚,无明显人机对抗,患者心率、血压波动情况较镇静前平稳。本组中有7例心率下降至<60次/分,降低给药速度后好转。所有患者均未出现明显呼吸抑制作用。结论重型颅脑损伤患者泵入适量右美托咪定进行镇静、镇痛,能减少患者躁动,降低颅内压,降低脑氧代谢率,抑制交感风暴,配合相关护理措施有助于改善预后,提高生存质量。

Objective To analyze the application efficacy of dexmedetomidine in the patients with severe craniocerebral injury, and to summarize corresponding nursing measures. Methods The clinical data of 63 patients with severe craniocerebral injury who received dexmedetomidine for sedation and analgesia were retrospectively analyzed. The condition of respiration, heart rate, blood pressure and acroteric oxygen saturation fluctuation of patients were observed during applica- tion of dexmedetomidine. Results After application of dexmedetomidine, the restlessness got better. A small dose of midazolam or propofol was combined for the patients with invasive respira- tor if necessary, there was no obvious man-machine counteraction, and the heart rate and blood pressure fluctuation became stable compared with pre-sedation. The heart rate of 7 out of 63 pa- tients decreased less than 60 times per minute, but got better after reduced administration speed. All the patients didnt suffer from respiratory depression obviously. Conclusion Moderate dose of dexmedetomidine in patients with severe craniocerebral injury for sedation and analgesia can re- duce the restlessness, decrease intracranial pressure and cerebral metabolic rate of oxygen, inhibit sympathetic storm, and improve prognosis and quality of life in combination of corresponding nursing measures.