右美托咪定对创伤性颅脑损伤患者术后脑氧代谢及认知功能影响分析

Effects of Dexmedetomidine on postoperative cerebral oxygen metabolism and cognitive function in patients with traumatic brain injury

目的分析右美托咪定对创伤性颅脑损伤(traumatic brain injury,TBI)患者术后脑氧代谢及认知功能的影响。方法选取自贡市第一人民医院2014年1月至2016年5月收治的170例TBI患者为研究对象,按照随机数表法将其分为观察组和对照组,每组各85例,所有患者均给予常规综合治疗、去骨瓣减压术或血肿清除术治疗,观察组患者术后加用右美托咪定静脉泵注。比较两组患者术后72小时内脑氧代谢指标变化情况,采用简易精神状况检查(mini-mental state examination,MMSE)评分评价两组患者术前、术后6小时及术后1~3天认知功能。结果术后12、24、48及72小时,两组患者心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、平均动脉压(mean arterial pressure,MAP)较术后即刻均逐渐下降(P<0.05),观察组患者HR、RR、MAP均显著低于对照组(P<0.05);两组患者术后脉搏血氧饱和度(pulse oxygen saturation,SpO_2)差异无显著性(P>0.05)。术后12、24、48及72小时,两组患者颈静脉球部血氧饱和度(jugular bulb venous oxygensaturation,SjvO_2)较术后即刻均逐渐升高(P<0.05),动脉-颈内静脉血氧含量差(arteriovenous oxygen content difference,AVDO2)和脑氧摄取率(cerebral extraction of oxygen,CERO2)均逐渐下降(P<0.05);除术后即刻外,观察组患者各时间点SjvO_2均显著高于对照组,AVDO2和CERO2均显著低于对照组(P<0.05)。术后6小时及术后1、2、3天,观察组患者MMSE评分均高于术后即刻(P<0.05),对照组患者MMSE评分未见明显变化(P>0.05)。观察组患者术后4周病死率为5.88%(5/85),对照组为8.24%(7/85),组间比较无显著差异(P>0.05);其余患者均获得有效随访,观察组患者术后4周美国国立卫生研究院卒中量表评分显著低于对照组(P<0.05),Fugl-Meyer评分显著高于对照组(P<0.05)。结论右美托咪定可降低TBI患者术后脑氧耗,纠正脑氧代谢紊乱,提高术后认知功能,对患者预后质量的改善具有积极作用。

Objective To analyze the effects of Dexmedetomidine on postoperative cerebral oxygen metabolism and cognitive function in patients with traumatic brain injury(TBI).Method170cases of TBI patients in Zigong First People's Hospital from January2014to May2016were selected as the research objects,they were randomly divided into observation group and control group,each of85cases,all patients were given conventional comprehensive and decompressive craniectomy or hematoma treatment,observation group patients were treated with dexmedetomidine intravenous injection.The changes of cerebral oxygen metabolism indexes were compared between the two groups within72hours after operation,and the cognitive function were evaluated by the mini-mental state examination(MMSE)scale before operation,6hours and1～3days after operation.Result12,24,48and72hours after operation,two groups of patients with heart rate(HR),respiratory rate(RR),and central venous pressure(MAP)were decreased compared with postoperative(P<0.05),the HR,RR and MAP in observation group were significantly lower than control group(P<0.05);there were no obvious changes in pulse oxygen saturation(SpO2)in the two groups after operationarterial(P>0.05).At12,24,48and72hours after operation,the jugular bulb venous oxygensaturation(SjvO2)were increased gradually in two groups(P<0.05),the arteriovenous oxygen content difference(AVDO2)and cerebral extraction of oxygen(CERO2)were decreased gradually(P<0.05).Except after operation,the SjvO2of observation group at each time point was significantly higher than that in control group(P<0.05),and AVDO2and CERO2were significantly lower than that of control group(P<0.05).6hours after operation and1,2and3days after operation,the MMSE scores of observation group were higher than those immediately after operation(P<0.05),and there were no obvious changes of MMSE scores in control group(P>0.05).4weeks after operation,the mortality rate of observation group was5.88%(5/85),control group was8.24%(7/85).There was no significant difference between the two groups(P>0.05),the other patients were followed up effectively,the National Institute of Health Stroke Scale(NIHSS)score of observation group was significantly lower than that of control group at4weeks after operation(P<0.05),and the score of Fugl-Meyer was significantly higher than that of control group(P<0.05).Conclusion Dexmedetomidine can inhibit cerebral oxygen consumption in patients with TBI,correct the cognitive function of cerebral oxygen metabolism,improve the postoperative,has a positive effect on the prognosis of patients and improve the quality,and worthy of promotion.