早期使用右美托咪定治疗重型颅脑损伤疗效观察

Effect of Dexmedetomindine in Early Treatment of Severe Craniocerebral Injuries

目的:探讨早期使用盐酸右美托咪定在重型颅脑损伤中的安全性及其神经保护作用。方法:选取益阳市中心医院2016年1月至2018年8月62例重型颅脑损伤患者,均有不同程度躁动不安,收治于神经外科监护室,入院后给予盐酸右美托咪定持续泵入镇静,记录并分析用药前及用药后30 min、1、6、12、24 h心率(HR)、呼吸频率(R)、血氧饱和度(SaO2)及动脉血氧分压(PaO2),并分析白介素-6(IL-6)及C反应蛋白(CRP)变化情况,将患者镇静至Ramsay评分2~4分的用量为维持剂量。结果:所有患者接受盐酸右美托咪定持续泵入后镇静效果满意,无过度镇静情况,用药后6、12、24 h时SaO2及PaO2明显升高,与用药前比较差异有统计学意义(P<0.05),用药后6、12、24 h患者R明显低于用药前,差异有统计学意义(P<0.05)。结论:盐酸右美托咪定持续泵入对重型颅脑损伤患者镇静效果满意,无呼吸抑制,安全性高,且能被唤醒,不过度影响神志判断,适用于重型颅脑损伤躁动患者的短期镇静。

Objective:To discuss the safety and neuroprotecive effect of early use of dexmedetomidine on patients with severe craniocerebral injuries.Methods:62 cases of severe craniocerebral injuries from January 2016 to August 2018 in the department of neurosurgery intensive care unit in Central Hospital of Yiyang City were studied.They all showed various degrees of restlessness,and were sedated with intravenous use of dexmedetomidine after admission.Heart rate(HR),respiratory rate(R),blood oxygen saturation(SaO2)and arterial partial pressure of oxygen(PaO2)before and 30 min,1,6,12,24 h after medication were recorded,and changes in interleukins-6(IL-6)and C-reactive protein(CRP)were analyzed.The drug dosage that sedated the patient to a Ramsay score of 2 to 4 was the maintenance dose.Results:All patients received satisfactory sedation after continuous pumping of dexmedetomidine,and there was no excessive sedation.SaO2 and PaO2 were significantly increased at 6,12 and 24 hours after the treatment,and the difference was statistically significant compared with that before treatment(P<0.05),the R of patients at 6,12 and 24 h after the treatment were significantly lower than those before the treatment,the difference was statistically significant(P<0.05).Conclusion:Dexmedetomidine has a satisfactory sedative effect on patients with severe craniocerebral injury,with no respiratory depression,high safety,and could make the patients be awaked easily when necessary,so it is suitable for short-term sedation on patients with severe craniocerebral injury and restlessness.