盐酸右美托咪定小剂量持续静脉泵入预防重型颅脑外伤患者应激性溃疡的效果

Prevention effect of stress ulcer in patients with severe craniocerebral trauma by low-dose continuous intravenous dexmedetomidine

目的分析右美托咪定对血清胃泌素水平的影响,以及预防重型颅脑外伤患者应激性溃疡的效果。方法选择2017年6月至2020年12月青岛大学附属医院神经外科监护室收治的76例重型颅脑外伤患者为研究对象。采用电脑随机分配方法分为右美托咪定组(观察组)39例和生理盐水安慰剂组(对照组)37例。入院后所有患者均接受单侧扩大翼点入路去骨瓣减压手术,观察组术后给予0.1μg/(kg·h)盐酸右美托咪定注射液持续静脉泵入;对照组术后给予生理盐水4 mL/(kg·h)持续静脉泵入。检测并比较术后第1、3、5、7天血清胃泌素水平,并比较两组术后消化道出血外情况。结果对照组术后第3、5、7天血清胃泌素水平明显高于观察组,差异有统计学意义(F=12.015,P<0.001)。两组患者血清胃泌素水平术后第3、5、7天高于术后第1天,不同时间点比较,差异有统计学意义(F=342.24,P<0.001),且存在交互作用(F=5.477,P=0.001)。76例患者大便潜血阳性率为35.53%,对照组大便潜血阳性率、肉眼血便发生率分别为48.65%、29.73%,观察组大便潜血阳性率、肉眼血便发生率分别为23.08%、7.69%,对照组明显高于观察组,差异有统计学意义(χ^(2)=5.421,P=0.020;χ^(2)=4.266,P=0.039)。结论小剂量静脉应用盐酸右美托咪定可降低血清胃泌素水平,有效预防重型颅脑外伤患者术后应激性溃疡。

Objective To analyze the effect of dexmedetomidine on serum gastrin level and prevention of stress ulcer in patients with severe craniocerebral trauma.Methods A total of 76 patients with severe craniocerebral injury admitted to the Neurosurgical Intensive Care Unit of the Affiliated Hospital of Qingdao University from June 2017 to December 2020 were selected as the study subjects,39 cases in dexmedetomidine group(observation group)and 37 cases in saline placebo group(control group)were randomly assigned by computer.On the day of admission,all patients underwent unilateral extended pterion approach to decompress the flap.The observation group was given 0.1μg/(kg·h)of dexmedetomidine hydrochloride injection continuously pumped intravenously after operation.The control group was given 4 mL/(kg·h)normal saline continuously pumped intravenously after operation.The levels of serum gastrin were detected and compared on the 1st,3rd,5th and 7th days after operation.The occurrence of gastrointestinal bleeding caused by stress was compared between the two groups.Results The serum gastrin level of control group was significantly higher than that of observation group on the 3rd,5th and 7th day after surgery,and the difference was statistically significant(F=12.015,P<0.001).The serum gastrin levels in the two groups on the 3rd,5th and 7th day after surgery were higher than on the 1st day after surgery,the differences were statistically significant at different time points(F=342.24,P<0.001),and there was an interaction(F=5.477,P=0.001).The positive rate of fecal occult blood in 76 patients was 35.53%.The positive rate of fecal occult blood and the incidence of gross blood stools in control group were 48.65%and 29.73%respectively,the positive rate of fecal occult blood and the incidence of gross blood stools in observation group were 23.08%and 7.69%respectively,which in control group were higher than those in observation group,with statistical significance(χ^(2)=5.421,P=0.020;χ^(2)=4.266,P=0.039).Conclusion Intravenous administration of low dose dexmedetomidine after operation for severe craniocerebral trauma could reduce serum gastrin level and effectively prevent stress ulcer.