瑞芬太尼联合咪达唑仑对重症颅脑损伤患者镇静及脑代谢的临床研究

Clinical Study on the Sedation Effect and Brain Metabolism of Remifentanil Combined with Midazolam in Patients with Severe Craniocerebral Injury

目的:研究瑞芬太尼联合咪达唑仑对重症颅脑损伤(SCI)患者镇静及脑代谢的临床效果。方法:选择2015年8月~2018年8月在本院接受治疗的120例SCI患者作为研究对象,依据不同治疗措施将其分为联合组(咪达唑仑注射液+注射用盐酸瑞芬太尼)和对照组(咪达唑仑注射液)各60例。治疗结束后观察比较两组RASS评分、Ricker镇静-躁动(SAS)评分、平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、动脉血氧饱和度(SaO2)、颈静脉血氧饱和度(SjvO2)、动脉血氧分压(PaO2)、颈静脉血氧分压(PjvO2)、脑氧代谢率(CMRO2)、不良反应发生率,所有数据采用SPSS 23.0软件进行统计分析。结果:治疗前,两组RASS评分、SAS评分、MAP、HR、CVP、SaO2、SjvO2、PaO2、PjvO2、CMRO2无统计学差异(P>0.05);治疗后,两组SAS评分、MAP、HR、CVP水平与治疗前比较有所下降,两组RASS评分、SaO2、SjvO2、PaO2、PjvO2、CMRO2水平与治疗前比较有所上升,具有统计学差异(P<0.05);治疗后,联合组SAS评分、MAP、HR、CVP水平低于对照组,RASS评分、SaO2、SjvO2、PaO2、PjvO2、CMRO2水平高于对照组,具有统计学差异(P<0.05);联合组不良反应发生率(8.33%)低于对照组(21.67%),具有统计学差异(P<0.05)。结论:瑞芬太尼联合咪达唑仑对SCI患者具有良好的镇静效果,能有效改善患者血流动力学及血气状态,从而使脑代谢恢复正常,安全性高,值得临床推广应用。

Objective:To investigate the sedation effect and brain metabolism of remifentanil combined with midazolam in patients with severe craniocerebral injury(SCI).Methods:120 cases of SCI patients in our hospital from August 2015 to August 2018 were enrolled and divided into two groups according to the different treatment methods,each with 60 cases.Combination group received midazolam injection and remifentanil,while control group received midazolam injection alone.Various indexes were compared between groups after treatment,including Ramsay sedation score(RASS),Ricker sedation-agitation scale(SAS),mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),arterial oxygen saturation(SaO2),jugular venous oxygen saturation(SjvO2),arterial partial pressure of oxygen(PaO2),jugular partial pressure of oxygen(PjvO2),cerebral metabolic rate of oxygen utilization(CMRO2),and incidence of adverse reactions.All data are statistically analyzed using SPSS 23.0 software.Results:No significant difference was found between groups in the RASS score,SAS score,MAP,HR,CVP,SaO2,SjvO2,PaO2,PjvO2,and CMRO2 before treatment(P>0.05).After treatment,the SAS scores,MAP,HR,and CVP levels in the two groups decreased in both groups(P<0.05),with more reduction found in the combination group than in the control group(P<0.05).Meanwhile,RASS scores,SaO2,SjvO2,PaO2,PjvO2,and CMRO2 levels increased in both groups(P<0.05),with more increase found in the combination group than in the control group(P<0.05).The total adverse reaction rate was significantly lower in the combination group than in the control group(8.33%vs 21.67%,P<0.05).Conclusion:Remifentanil combined with midazolam has a significant sedative effect on SCI patients.It can effectively and safely improve the hemodynamics and blood gas status,so as to restore normal brain metabolism,which is worthy of clinical application.