DEX与异丙酚在中重度颅脑损伤患者镇痛镇静中的应用效果及对血清β-内啡肽、炎症因子、脑氧代谢的影响

Effect of DEX and propofol on analgesic sedation in patients with TBI and its effect on serum β-EP,inflammatory factors and cerebral oxygen metabolism

目的探讨中重度颅脑损伤(TBI)患者采用右美托咪定(DEX)、异丙酚进行镇痛镇静的效果。方法对平煤神马医疗集团总医院2015年1月—2016年12月收治的119例中重度TBI患者进行前瞻性研究,采用随机数字表法分为DEX组59例、异丙酚组60例;对比两组患者的镇痛镇静效果(Riker评分),给药前与给药12h后的血清皮质醇、β-内啡肽(β-EP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、脑氧含量(Cjv O2)、动脉-颈内静脉球部血氧差[D-(a-jv) O2]、脑氧摄取率(CEO2)的变化。结果给药前,两组患者的Riker评分差异无统计学意义(P> 0. 05);给药2、4、12h后DEX组的Riker评分均低于异丙酚组(P <0. 05)。给药前,两组患者的血清皮质醇、β-EP水平差异无统计学意义(P>0. 05);给药12h后,DEX组的血清皮质醇、β-EP水平均低于异丙酚组(P <0. 05)。给药前,两组患者的血清IL-6、IL-10、TNF-α水平差异无统计学意义(P> 0. 05);给药12h后,DEX组的血清IL-6、IL-10、TNF-α水平均低于异丙酚组(P <0. 05)。给药前,两组患者的Cjv O2、D-(a-jv) O2、CEO2水平差异无统计学意义(P>0. 05);给药12h后,DEX组的D-(a-jv) O2、CEO2水平均低于异丙酚组(P <0. 05),Cjv O2水平高于异丙酚组(P <0. 05)。结论中重度TBI患者采用DEX镇痛镇静的效果优于异丙酚,并且有利于减轻患者的炎症应激反应、改善患者的脑氧代谢水平,具有一定的临床应用价值。

Objective To investigate the effects of DEX and propofol on sedation and analgesia in patients with moderate to severe TBI.Methods A prospective study was conducted on119patients with moderate to severe TBI who were admitted to the General Hospital of Pingmei Shenma Medical Group from Jan.2015to Dec.2016.The random number table method was used to divide patients into DEX group(59cases)and propofol group(60cases).The sedative and analgesic effects,and the changes in the erum cortisol,β-EP,IL-6,IL-10,TNF-α,CjvO2,D-(a-jv)O2and CEO2were observed and compared between the two groups before and12h after drug administration.Results Before the administration,the difference of Riker score between the two groups was not statistically significant(P>0.05).The Riker scores of the DEX group were lower than those of the propofol group at2h,4h,and12h after administration(P<0.05).There was no significant difference in serum cortisol andβ-EP levels between the two groups before administration(P>0.05).After12h of administration,serum cortisol andβ-EP levels in the DEX group were lower than those in the propofol group(P<0.05).Before administration,the levels of serum IL-6,IL-10and TNF-αin the two groups were not statistically significant(P>0.05).After12h of administration,the levels of serum IL-6,IL-10and TNF-αin the DEX group were lower than those in the propofol group(P<0.05).There was no significant difference in CjvO2,D-(a-jv)O2,and CEO2levels between the two groups before administration(P>0.05).After12h of administration,the D-(a-jv)O2and CEO2levels in the DEX group were lower than those in the propofol group(P<0.05),and the level of CjvO2was higher than that of propofol group(P<0.05).Conclusion The effect of DEX for analgesia and sedation in patients with moderate to severe TBI is better than that of propofol,and it is beneficial to reduce the inflammatory stress response and improve the level of cerebral oxygen metabolisms.