地佐辛联合右美托咪定对重型颅脑外伤机械通气患者颅内压和拔管应激反应的影响

Effect of Dezocine Combined with Dexmedetomidine on Intracranial Pressure and Extubation Stress Response in Patients with Severe Brain Injury Undergoing Mechanical Ventilation

目的:探讨地佐辛联合右美托咪定(Dex)对重型颅脑外伤(SBI)机械通气患者颅内压(ICP)和拔管应激反应的影响。方法:选择2019年2月—2020年12月50例SBI患者,术后入ICU行机械通气继续治疗,随机均分为研究组和对照组。对照组给予Dex,负荷量0.5μg/kg,15min匀速泵注,维持量0.2~0.5μg/(kg·h);研究组于对照组基础上给予地佐辛,负荷量0.1mg/kg,15min匀速泵注,维持量0.02~0.04mg/(kg·h)。记录两组泵注前、泵注12h、24h、48h ICP,比较两组拔管前(T_(1))、拔管即刻(T_(2))、拔管后5min(T_(3))MAP、HR变化。结果:泵注12h、24h、48h,研究组ICP均低于对照组(P<0.05)。T_(1)、T_(3)时两组MAP、HR比较差异无统计学意义(P>0.05),T_(2)时研究组MAP、HR均低于对照组(P<0.05)。结论:地佐辛联合Dex改善SBI机械通气患者的ICP,减轻拔管应激反应。

Objective:To investigate the effect of dezocine combined with dexmedetomidine(Dex)on intracranial pressure(ICP)and extubation stress in patients with severe brain injury(SBI)undergoing mechanical ventilation.Methods:50 patients with SBI,selected from February 2019 to December 2020,were randomly divided into the study group and the control group on averagely.The control group was given Dex with loading dose 0.5μg/kg in 15 minutes and maintenance dose 0.2~0.5μg/(kg·h);the study group was given dezocine with loading dose 0.1mg/kg in 15 minutes and maintenance dose 0.02~0.04mg/(kg·h)on the basis of the control group.ICP was recorded before pumping and at 12,24,48 hours after pumping.The changes of MAP and HR were compared in the two groups before extubation(T_(1)),immediately after extubation(T_(2))and 5 minutes after extubation(T_(3)).Results:ICP in the study group were lower than those in the control group at 12,24,48 hours after pumping(P<0.05).There were no significant difference in MAP and HR at T_(1) and T_(3) in two groups(P>0.05).MAP and HR in the study group were lower than those in the control group at T_(2)(P<0.05).Conclusion:Dezocine combined with Dex could improve ICP and relieve extubation stress in patients with SBI undergoing mechanical ventilation.