艾司洛尔联合右美托咪定对重型颅脑创伤术后颅内压波动和脑脊液生物标志物的影响

Effects of Esmolol Combined with Dexmedetomidine on Intracranial Pressure Fluctuation and Cerebrospinal Fluid Biomarkers of Patients with Severe Traumatic Brain Injury After Surgery

目的探讨术后联用艾司洛尔和右美托咪定对重型颅脑创伤患者颅内压波动和脑脊液神经元特异性烯醇化酶(NSE)、脑活性肽100β蛋白(S100β)水平的影响。方法回顾性分析医院2020年1月至2021年6月收治的行去骨瓣减压术后的重型颅脑创伤患者138例,按治疗用药的不同分为A组(78例,右美托咪定)和B组(60例,艾司洛尔+右美托咪定),均治疗7 d。结果两组患者的给药方案与时间对颅内压相关指标、脑脊液NSE、S100β及谷氨酸(Glu)均存在交互作用(P<0.05),给药方案与时间对颅内压相关指标、脑脊液NSE、S100β及谷氨酸(Glu)主效应均显著(P<0.05)。术毕,两组患者颅内压平均值无显著差异(P>0.05);治疗后第1,3,7天,B组的颅内压、颅内压波动值、平均颅内压波幅均显著低于A组(P<0.05),脑灌注压显著高于A组(P<0.05)。治疗后第7天,两组脑电图异常程度均较前减轻,但组间无显著差异(P>0.05)。治疗后第1,3,7天,B组NSE,S100β,Glu均显著低于A组(P<0.05)。治疗后第14天,B组患者格拉斯哥昏迷量表(GCS)和格拉斯哥预后量表(GOS)评分均显著高于A组(P<0.05);出院后6个月,两组患者GCS和GOS评分均无显著差异(P>0.05)。A组和B组不良反应发生率相当(24.36%比25.00%,P>0.05)。结论艾司洛尔联合右美托咪定能降低重型颅脑创伤患者术后的颅内压,改善脑电异常,降低脑脊液NSE,S100β,Glu水平,改善短期预后,且安全性良好。

Objective To investigate the effect of esmolol combined with dexmedetomidine on the intracranial pressure fluctuation,neuron-specific enolase(NSE)and brain active peptide 100β protein(S100β)levels in the cerebrospinal fluid of patients with severe traumatic brain injury after surgery.Methods A total of 138 patients with severe traumatic brain injury after the decompressive craniectomy admitted to the hospital from January 2020 to June 2021 were retrospectively analyzed and divided into the group A(78 cases,treated with dexmedetomidine)and the group B(60 cases,treated with esmolol+dexmedetomidine)according to the different drugs.Both groups were treated for 7 d.Results There was an interaction between the administration scheme and time in the two groups on the intracranial pressure-related indexes,NSE,S100β and glutamate(Glu)in the cerebrospinal fluid(P<0.05),and the administration scheme and time had significant major effects on the above indexes(P<0.05).After the surgery,the mean intracranial pressure in the group B was similar to that in the group A(P>0.05).On the first,third and seventh days after treatment,the intracranial pressure,intracranial pressure fluctuation and mean intracranial-pressure wave amplitude(MWA)in the group B were significantly lower than those in the group A(P<0.05),and the cerebral perfusion pressure(CPP)in the group B was significantly higher than that in the group A(P<0.05).On the seventh day after treatment,the electroencephalogram(EGG)abnormality in the two groups alleviated,but that in the group B was similar to that in the group A(P>0.05).On the first,third and seventh days after treatment,NSE,S100β and Glu levels in the group B were significantly lower than those in the group A(P<0.05).On the 14th day after treatment,the scores of Glasgow Coma Scale(GCS)and Glasgow Outcome Scale(GOS)in the group B were significantly higher than those in the group A(P<0.05).In the sixth month after discharge,the scores of GCS and GOS in the group B were similar to those in the group A(P>0.05).The incidence of adverse reactions in the group A was similar to that in the group B(24.36%vs.25.00%,P>0.05).Conclusion Esmolol combined with dexmedetomidine can reduce the intracranial pressure,improve EEG abnormality,reduce the NSE,S100β and Glu levels in cerebrospinal fluid,improve the short-term prognosis of patients with severe traumatic brain injury after surgery,and it has good safety.