右美托咪定镇静治疗对急性颅脑损伤患者脑血流、脑氧代谢的影响

Effects of dexmedetomidine sedation on cerebral blood flow and cerebral oxygen metabolism in patients with acute craniocerebral injury

目的观察右美托咪定对急性颅脑损伤患者的镇静效果,并探讨其对脑血流、脑氧代谢的影响。方法选取宁波市北仑区人民医院2018年12月至2020年4月收治的急性颅脑损伤患者68例,采用随机数字表法分为对照组(n=34)和观察组(n=34)。两组术后转入重症医学科(ICU)均给予常规综合治疗,观察组在常规治疗基础上加用右美托咪定0.5μg·kg^-1·h^-1静脉泵入,维持3 d。比较两组平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)、Ramsay评分、格拉斯哥昏迷评分(GCS)、脑血流量(CBF)、颈静脉球部血氧饱和度(SjvO2)、颈内动脉与颈内静脉血氧含量差(AVDO2)及脑氧摄取率(CERO2)变化。结果观察组转入ICU后24 h、72 h时MAP[(89.05±10.91)mmHg、(90.24±9.40)mmHg]、HR[(82.42±9.51)次/min、(81.18±8.26)次/min]、RR[(27.03±5.20)次/min、(26.38±4.75)次/min]均显著低于对照组[(109.49±10.41)mmHg、(103.63±11.68)mmHg,(109.52±8.37)次/min、(104.46±9.16)次/min,(32.76±5.71)次/min、(29.59±4.40)次/min](t=7.904、5.208、12.473、11.006、4.326、2.891,均P<0.05),两组各时间点SpO2差异均无统计学意义(均P>0.05)。转入ICU后72 h,观察组Ramsay评分[(2.72±0.35)分]低于对照组[(3.42±0.40)分],GCS评分[(11.92±1.81)分]高于对照组[(10.14±2.28)分],差异均有统计学意义(t=7.679、3.565,均P<0.05);观察组CBF、AVDO2和CERO2均较0 h降低(t=2.406、4.908、6.291,均P<0.05),且均显著低于对照组(t=2.087、5.493、6.423,均P<0.05);观察组SjvO2[(61.27±4.70)%]较0 h[(51.44±3.48)%]升高(t=9.801,P<0.05),且显著高于对照组[(53.32±3.64)%](t=7.798,P<0.05)。结论右美托咪定可改善急性颅脑损伤患者术后镇静效果,稳定生命体征,降低脑氧耗及改善脑氧代谢紊乱。

Objective:To observe the sedative effect of dexmedetomidine(DEX)on patients with acute craniocerebral injury(ACI),and to explore its influences on cerebral blood flow(CBF)and cerebral oxygen metabolism.Methods:A total of 68 ACI patients were randomly divided into control group(n=34)and observation group(n=34)according the random digital table method.The patients in both two groups were transferred to intensive care unit(ICU)for routine comprehensive treatment after surgery.On this basis,the observation group was given intravenous injection of 0.5μg·kg^-1·h^-1 DEX for 3d.The changes of mean arterial pressure(MAP),heart rate(HR),respiration rate(RR),blood oxygen saturation(SpO2),scores of Ramsay and Glasgow Coma Scale(GCS),CBF,jugular bulb venous oxygen saturation(SjvO2),arteriovenous oxygen content difference(AVDO2)and cerebral oxygen extraction rate(CERO2)were compared between the two groups.Results:At 24h and 72h after being transferred to ICU,MAP[(89.05±10.91)mmHg,(90.24±9.40)mmHg],HR[(82.42±9.51)times/min,(81.18±8.26)times/min]and RR[(27.03±5.20)times/min,(26.38±4.75)times/min]in the observation group were significantly lower than those in the control group[(109.49±10.41)mmHg,(103.63±11.68)mmHg,(109.52±8.37)times/min,(104.46±9.16)times/min,(32.76±5.71)times/min,(29.59±4.40)times/min](t=7.904,5.208,12.473,11.006,4.326,2.891,all P<0.05).There was no statistically significant difference in SpO2 between the two groups(P>0.05).At 72h,the Ramsay score in the observation group was lower than that in the control group[(2.72±0.35)points vs.(3.42±0.40)points],while the GCS score was higher than that in control group[(11.92±1.81)points vs.(10.14±2.28)points],and there were statistically significant differences between the two groups(t=7.679,3.565,all P<0.05).At 72h,the CBF,AVDO2 and CERO2 were lower than those at 0h in the observation group(t=2.406,4.908,6.291,all P<0.05),which were significantly lower than those in the control group(t=2.087,5.493,6.423,all P<0.05).At 72h,the SjvO 2 was higher than that at 0h in the observation group[(61.27±4.70)%vs.(51.44±3.48)%](t=9.801,P<0.05),which was significantly higher than that in the control group[(53.32±3.64)%](t=7.798,P<0.05).Conclusion:DEX can improve postoperative sedation effect of ACI patients,stabilize vital signs,reduce cerebral oxygen consumption and improve cerebral oxygen metabolism disorders.