盐酸右美托咪定复合羟考酮在急性颅脑创伤患者麻醉中的应用效果

Application effect of dexmedetomidine hydrochloride(Dex)combined with oxycodone in anesthesia for patients with acute craniocerebral trauma

目的分析盐酸右美托咪定(Dex)复合羟考酮在急性颅脑创伤患者麻醉中的应用效果。方法将巴中市中心医院2018年12月-2019年8月收治的80例急性颅脑创伤患者依照随机信封法分为对照组及观察组,每组40例。对照组患者采用羟考酮方案麻醉,观察组采用Dex复合羟考酮方案麻醉。记录两组患者术后清醒时间、拔管时间;检测两组患者手术前后桡动脉血氧饱和度(SjvO_(2))、血氧含量(CjvO_(2))、静脉动脉血氧含量(CaO_(2))、神经元特异性烯醇化酶(NSE)、S-100B、PKB、Akt水平;并在两组患者清醒后即刻(T1)、清醒后6 h(T2)、清醒后12 h(T3)及清醒后24 h(T4)采用视觉模拟评分(VAS)法评估患者的疼痛情况。结果两组术后清醒时间及拔管时间比较,差异均无统计学意义(P>0.05)。两组术后CjvO_(2)、SjvO_(2)、CaO_(2)水平均低于术前,但观察组高于对照组,差异均有统计学意义(P<0.05)。两组术后血NSE、S-100B、PKB及Akt水平均高于术前,但观察组血NSE、S-100B、PKB水平低于对照组,Akt水平高于对照组,差异均有统计学意义(P<0.05)。整体分析发现:VAS组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05);组内比较:不同时间点两组各组内VAS存在显著性差异(P<0.05);组间比较:同一时间点不同组别患者VAS存明显差异(P<0.05)。结论采用Dex复合羟考酮对急性颅脑创伤干预后可有效改善患者的脑氧代谢,并激活PKB/Akt途径。

Objective To analyze application effct of Dex combined with oxycodone in anesthesia for patients with acute craniocerebral trauma.Methods 80 patients with acute craniocerebral trauma admitted to Bazhong Central Hospital from December 2018 to August 2019 were divided into control group and observation group according to the random envelope method,40 cases in each group.The control group was anesthetized with oxycodone regimen,and the observation group was treated with Dex in accordance with oxycodone regimen anesthesia.The postoperative awake time and extubation time of two groups were recorded.The levels of SjvO_(2),CjvO_(2),CaO_(2),NSE,S-100B,PKB and Akt of two groups were measured before and after operation.The pain of two groups was evaluated by VAS immediately after waking(T1),6 h after waking(T2),12 h after waking(T3)and 24 h after waking(T4).Results There was no significant difference in postoperative awake time and extubation time between two groups(P>0.05).After operation,the levels of Cj-vO2,SjvO_(2),CaO_(2)in two groups were lower than those before operation,but those in observation group were higher than those in control group,the differences were statistically significant(P<0.05).After operation,the levels of NSE,S-100B,PKB and Akt in two groups were higher than those before operation,but the levels of NSE,S-100B and PKB in.observation group were lower than those in control group,and Akt level in observation group was higher than that in control group,the differences were statistically significant(P<0.05).The overall analysis showed that there were significant differences in VAS of group comparison,time point comparison and interaction comparison(P<0.05).Comparison within the group:there was significant difference in VAS between two groups at different time points(P<0.05).Comparison among groups:at the same time point,there was significant difference in VAS among different groups(P<0.05).Conclusion After the intervention of Dex combined with oxycodone on acute craniocerebral trauma,it can effectively improve the cerebral oxygen metabolism of patients and activate PKB/Akt pathway。