艾司洛尔联合右美托咪定对重型颅脑创伤患者去骨瓣减压术后脑代谢及预后的影响

The effect of dexmedetomidine-esmolol combination therapy on metabolism and outcome in patients with severe traumatic brain injury undergoing decompression craniectomy

目的探讨艾司洛尔联合右美托咪定对重型颅脑创伤去骨瓣减压术患者脑脊液(CSF)中乳酸、S100B表达,颅内压(ICP)以及预后的影响。方法选取2015年1月—2018年12月行单侧去骨瓣减压的重型颅脑创伤患者60例为观察对象,采用随机信封法分为艾司洛尔联合右美托咪定治疗组(联合治疗组,30例)与单用右美托咪定治疗组(对照组,30例)。记录治疗前和治疗后1、3、7 d颅内压变化及CSF中乳酸和S100B蛋白水平,比较2组患者治疗后14 d格拉斯哥昏迷(GCS)评分和美国国立卫生研究院卒中量表(NIHSS)评分及不良反应发生情况。出院后共随访6个月,采用Glasgow预后分级(GOS)评价2组患者的预后。结果联合治疗组患者治疗后1、3、7 d其CSF乳酸含量、S100B水平和ICP均低于对照组(P<0.05);联合治疗组治疗后14 d GCS评分及NIHSS评分高于对照组(P<0.01);出院后6个月随访时2组患者GOS评分差异无统计学意义(P>0.05)。结论艾司洛尔联合右美托咪定联合治疗可降低重型颅脑创伤去骨瓣术患者CSF乳酸水平和S100B蛋白表达,改善患者的短期预后,但并未改善长期预后。

Objective To explore the effect of dexmedetomidine-esmolol combination therapy on the lactic acid contents,the levels of S100B,intracranial pressure(ICP)and outcome in patients with severe traumatic brain injury undergoing decompression craniectomy.Methods Sixty patients with severe craniocerebral trauma who underwent unilateral craniocerebral decompression from January 2015 to December 2018 were selected as the observation objects.According to the application of postoperative sedative drugs,the patients were divided into two groups:the co-treatment group of esmolol combined with dexmedetomidine(the co-treatment group,n=30)and the control group of dexmedetomidine alone(the control group,n=30).Cerebrospinal fluid(CSF)was collected before treatment and on 1,3 and 7 d after treatment.The lactic acid contents and the levels of S100B of the CSF were detected.Glasgow coma scale(GCS)score and National Institute of Health stroke scale(NIHSS)score were compared 14 d after treatment between the two groups.Glasgow outcome scale(GOS)score were used to evaluate long-term outcome on 6 months after treatment.Results After treatment,CSF lactic acid content and S100B level decreased significantly at 1,3 and 7 d after treatment in co-treatment group than those of the control group(P<0.05).The GCS score and NIHSS score were significantly higher at 14 d after treatment in the cotreatment group than those in the control group(P<0.01).There was no significant difference in the GOS score within 6-month follow up between the two groups of patients(P>0.05).Conclusion Dexmedetomidine-esmolol combination therapy can reduce the levels of CSF lactic acid and S100B in patients with severe traumatic brain injury undergoing decompression craniectomy and improve the short-term outcome,but it has no significant effect on the long-term prognosis.