盐酸羟考酮在创伤性重型颅脑损伤术中的应用效果

Application effect of oxycodone hydrochloride in traumatic severe craniocerebral injury

目的探究盐酸羟考酮复合丙泊酚在创伤性重型颅脑损伤术中的麻醉效果及脑保护作用。方法前瞻性选取2020-01—2022-01鹤煤总医院进行手术治疗的创伤性重型颅脑损伤患者68例为研究对象,按照随机数字表法分为研究组与对照组各34例。2组患者均行全身麻醉,对照组麻醉维持给予丙泊酚+瑞芬太尼,手术结束前15~20 min静脉注射舒芬太尼预镇痛;研究组麻醉维持给予丙泊酚+盐酸羟考酮,手术结束前15~20 min静脉注射盐酸羟考酮镇痛。比较2组麻醉效果、Ramsay镇静情况、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、脑血流指标[颈静脉血氧饱和度(SjvO_(2))、动脉-颈内静脉血氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2))]、神经元特异性烯醇化酶(NSE)及S-100β蛋白水平差异。结果研究组患者的自主呼吸时间、苏醒时间、术后拔管时间、术中MAP及术后HR值均低于对照组(P<0.05),且其麻醉5 min、30 min及60 min的Ramsay镇静情况评分分别为(3.88±1.21)分、(3.23±0.49)分、(3.44±0.61)分,均低于对照组的(5.59±1.42)分、(4.68±0.64)分、(5.00±0.49)分(P<0.05)。组间比较,T1、T2及T3时刻,研究组TNF-α、IL-6、S-100β、NSE、SjvO_(2)值均低于对照组(P<0.05),Da-jvO_(2)、CERO_(2)值均高于对照组,差异均具有统计学意义(P<0.05)。结论盐酸羟考酮复合丙泊酚应用于创伤性重型颅脑损伤术中的镇静及镇痛效果均较好,可降低脑组织应激及炎症反应,具有更好的脑保护作用。

Objective To explore the anesthesia effect and brain protection effect of oxycodone hydrochlo⁃ride combined with propofol in traumatic severe traumatic brain injury surgery.Methods A total of 68 patients with severe traumatic brain injury who underwent surgical treatment in our hospital from January 2020 to January 2022 were prospectively selected as the research objects,and were divided into the study group and the control group according to the random number table method,with 34 cases in each.Both groups of patients were given general anesthesia,the control group was given propofol+remifentanil for maintenance anesthesia,and sufentanil was intravenously injected 15-20 minutes before the end of the operation for pre-analgesia.The study group was given propofol+oxycodone hydrochloride for maintenance anesthesia oxycodone hydrochloride was administered intravenously 15 to 20 minutes before the end of the operation for analgesia.The anesthesia effect,Ramsay seda⁃tion,inflammatory factors(tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)),blood gas indexes(jugular vein oxygen saturation(SjvO_(2)),Differences in arterial-internal jugular vein oxygen content(Da-jvO_(2)),cerebral oxy⁃gen uptake rate(CERO_(2))),neuron-specific enolase(NSE)and S-100βprotein levels.Results The spontaneous breathing time,recovery time,postoperative extubation time,intraoperative MAP and postoperative HR values of the study group were lower than those of the control group(P<0.05),and the Ramsay sedation scores at 5 min,30 min and 60 min of anesthesia were respectively were(3.88±1.21)points,(3.23±0.49)points,(3.44±0.61)points,all lower than the control group(5.59±1.42)points,(4.68±0.64)points,(5.00±0.49)points(P<0.05).At T1,T2 and T3,the values of TNF-α,IL-6,S-100β,NSE and SjvO_(2)in the study group were lower than those in the control group(P<0.05),and the values of Da-jvO_(2)and CERO_(2)were higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion Oxycodone hydrochloride combined with propofol has good sedative and analgesic effects in traumatic severe craniocerebral injury,can reduce brain tissue stress and inflammatory response,and has better brain protection.